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