diabetes team and cgm in managing hospitalised patients with diabetes

Conditions: Diabetes Mellitus, Type 2

Summary: this trial investigates the effects of continuous glucose monitoring (cgm) and an in-hospital diabetes team on in-hospital glycemic and clinical outcomes in patients with type 2 diabetes compared to standard glucose point-of-care (poc) testing and an in-hospital diabetes team.

in denmark and worldwide, 15-20 % of hospitalised patients have diabetes mellitus. for most patients, diabetes is not the primary cause of admission. the patients are therefore under the care of non-diabetes specialists. consequently, diabetes management can be inadequate resulting in hypoglycemia, hyperglycemia, and increased glycemic variability, which might increase patient mortality, morbidity, and length of hospital stay. despite these challenges, a recent review concludes that in-hospital diabetes management is under-researched. therefore, new in-hospital diabetes management strategies are greatly needed. continuous glucose monitoring (cgm) might accommodate this need by providing 288 glucose readings per day compared to usual glucose point-of-care (poc) testing from finger-prick blood 3-5 times per day during admission. cgm glucose levels can be transmitted from the patient's room to a monitoring screen at the nursing stations. this setup is called telemetric cgm. outstanding results on glycemic and clinical outcomes in an out-hospital setting exist, however, in-hospital cgm has been associated only with a clinically insignificant reduction of mean daily glucose levels and a small increased detection rate of hypoglycemia of glucose levels \<3 mmol/l (\<54 mg/dl) compared to poc. reasons for this might be that an in-hospital diabetes team (i.e., educated diabetes nurses with cgm competencies) is imperative in achieving optimal use of telemetric cgm. this trial investigates if telemetric cgm and an in-hospital diabetes team improve patients' in-hospital glycemic and clinical outcomes compared to poc glucose testing and an in-hospital diabetes team

Eligibility criteria:
inclusion criteria: * a documented history of t2dm prior to inclusion * age ≥ 18 years old * willingness and ability to comply with the clinical investigation plan * ability to communicate in danish with the trial personnel * an expected length of hospital stay for at least two days after enrolment * if subject with childbearing potential (subject \< 50 years old); willing to have a urine pregnancy test performed and/or to use a highly effective method of contraception (i.e., birth control implant, intrauterine device, birth control shot, or sterilisation). exclusion criteria: * patients on out-hospital basal insulin with duration of action \> 24 hours (toujeo or tresiba) * treated with hydroxyurea/hydroxycarbamid * nutritional therapy (continuous enteral or parenteral feeding) * clinically relevant pancreatic disease * systemic glucocorticoid treatment with prednisone equivalent dose \>5 mg/day * expected to require admission to the intensive-care unit * anasarca (severe and general edema) * dialysis * estimated glomerular filtration rate (egfr) \<15 ml/min/1.73 m2 * known hypersensitivity to the band-aid of the cgm dexcom g6 sensor.

Keywords: inpatient randomised controlled trial hyperglycemia hypoglycemia glycemic variabiity continuous glucose monitoring cgm in-hospital telemetric continuous glucose monitoring