Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study
Authors: Hirsch Irl B. , Draznin Boris , Buse John B. , Raghinaru Dan , Spanbauer Charles , Umpierrez Guillermo E. , Ullal Jagdeesh , Jones Morgan S. , Low Wang Cecilia C. , Spanakis Elias K. , Chao Jing H. , Sibayan Judy , Kollman Craig , Zabala Zohyra E. , Moazzami Bobak , Reynolds Shari L. , Ferrara Wanda , Fulghum Karla , Kass Alex , Armstrong Chase , Gilani Faryal , Seggelke Stacey , Churchill Jade , Monye Joseph O. , Choe Monica Y. , Scott William , Baran Jesica D. , Bais Rajlaxmi , Khakpour Dori , Pasquel Francisco J. , Davis Georgia M. , Vellanki Priyathama , Kershaw Erin E. , Gligorijevic Nikola , Goley April , Garg Avni , Alexander Bonnie , Matson Brooke C. , Diner Jamie , Klein Klara R. , Adair Whitney B. , Choksi Palak , Huang Michelle , Vinh Jennifer , Singh Lakshmi G. , Beck Roy W. ,   TIGHT RCT Study Group, Spanakis Elias K. , Choe Monica Y. , Monye Joseph O. , Scott William , Churchill Jade , Singh Lakshmi G. , Umpierrez Guillermo E. , Pasquel Francisco J. , Davis Georgia M. , Zabala Zohyra E. , Moazzami Bobak , Vellanki Priyathama , Low Wang Cecilia C. , Draznin Boris , Seggelke Stacey , Adair Whitney B. , Choksi Palak , Huang Michelle , Vinh Jennifer , Graham Paige , Jones Morgan S. , Fulghum Karla , Buse John B. , Donahue Cassandra , Kass Alex , Matson Brooke C. , Ravulapally Sirisha , Armstrong Chase , Fraser Rachael , Alexander Bonnie , Diner Jamie , Garg Avni , Goley April , Hudson Veronica , Gilani Faryal , Klein Klara R. , Morba Catherine , Velez Carlos , Te Vazquez Jenny , Ullal Jagdeesh , Kershaw Erin E. , Gligorijevic Nikola , Reynolds Shari L. , Ferrara Wanda , Henry Arley , Rial Emmaline , Chao Jing H. , Bais Rajlaxmi , Khakpour Dori , Baran Jesica , Hirsch Irl B. , Beck Roy , Sibayan Judy , Davis Julie , Kollman Craig , Raghinaru Dan , Spanbauer Charles , McNabb David , Guzzetta Russell , Ubas Camille , Lingvay Ildi , Weinstock Ruth , McGill Janet 
Published: November 2024

OBJECTIVE

To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

At six academic hospitals, adults with type 2 diabetes hospitalized in a non–intensive care setting were randomly assigned to either standard therapy with glucose target 140–180 mg/dL (standard group) or intensive therapy with glucose target 90–130 mg/dL guided by CGM (intensive group). The primary outcome was mean glucose measured with CGM (blinded in standard group), and the key secondary outcome was CGM glucose &lt;54 mg/dL.

RESULTS

For the 110 participants included in the primary analysis, mean ± SD age was 61 ± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL for the intensive group (n = 60) vs. 175 mg/dL for the standard group (n = 50; risk-adjusted difference −7 mg/dL, 95% CI −19 to 5; P = 0.25). Only 7% of the intensive group achieved the mean glucose target range of 90–130 mg/dL. CGM readings &lt;54 mg/dL were infrequent (0.2% for intensive and 0.4% for standard; adjusted treatment group difference −0.1%, 95% CI −0.6 to 0.3). One severe hypoglycemia event occurred in the standard group.

CONCLUSIONS

The study’s glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non–intensive care unit hospital setting. A glucose target of 90–130 mg/dL may not be realistic in the current environment of insulin management in the hospital.