Taking a Closer Look—Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus Under Basal-Bolus Insulin Therapy

Schaupp, Lukas; Donsa, Klaus; Neubauer, Katharina; Mader, Julia K.; Aberer, Felix; Höll, Bernhard; Spat, Stephan; Augustin, Thomas; Beck, Peter; Pieber, Thomas R.; Plank, Johannes

doi:10.1089/dia.2014.0343

Cited by 38 publications

(39 citation statements)

References 30 publications

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“…First of all, the study was a single‐arm study without a direct comparator, as the primary purpose was to show that the GlucoTab algorithm can be used without modifications in combination with insulin glargine U300. The sample size was rather small as previous studies have indicated that 15 to 30 patients can provide deep insight into 24‐hour glycaemia when using CGM . Furthermore, this trial was performed in an endocrinology ward with highly experienced staff that was already familiar with GlucoTab.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was rather small as previous studies have indicated that 15 to 30 patients can provide deep insight into 24-hour glycaemia when using CGM. 10,12,38 Furthermore, this trial was performed in an endocrinology ward with highly experienced staff that was already familiar with GlucoTab. In summary, basal-bolus insulin therapy using GlucoTab in combination with insulin glargine U300 can be safe and efficacious without an increase in hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

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GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

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Aims To investigate efficacy, safety and usability of the GlucoTab system for glycaemic management using insulin glargine U300 in non‐critically ill hospitalized patients with type 2 diabetes (T2D). Materials and Methods In this open, non‐controlled single‐arm pilot study, glycaemic control at the general ward of a tertiary care hospital was guided by a mobile decision support system (GlucoTab) for basal‐bolus insulin dosing using the novel basal insulin analogue insulin glargine U300 for the first time. Glycaemic control was surveilled with capillary glucose measurements and continuous glucose monitoring (CGM). The primary endpoint was efficacy of glycaemic management, defined as the percentage of blood glucose measurements within the target range of 3.9 to 7.8 mmol/L. Results A total of 30 patients with T2D (12 female; age, 67 ± 11 years; HbA1c, 70 ± 26 mmol/mol; BMI, 31.8 ± 5.6 kg/m 2 ; length of study, 8.5 ± 4.5 days) were included. In total, 894 capillary glucose values and 49 846 data points of CGM were available, of which 56.1% of all measured capillary glucose values and 54.3% of CGM values were within the target area (3.9‐7.8 mmol/L). Overall capillary mean glucose was 8.5 ± 1.2 and 8.4 ± 1.2 mmol/L assessed by CGM. Time within glucose target improved continuously during the course of treatment, while time within hypoglycaemia (<3.9 mmol/L) decreased substantially. The GlucoTab‐suggested total daily dose was accepted by staff in 97.3% of situations. Conclusions Treatment with GlucoTab using insulin glargine U300 in hospitalized patients with T2D is effective and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

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“…Several clinical studies comparing POC-GM and CGM in hospitalized patients have highlighted the benefits of the latter in general ward settings [66]. Schaupp et al [67] applied blinded CGM to 84 hospitalized patients with Type 2 diabetes in a general ward, and retrospectively compared CGM values with four-daily POC-GM measurements over a period of 501 patient-days. The authors reported that the number of nocturnal hypoglycaemic episodes (<3.9 mmol/l) detected by CGM was 15-fold higher than the number detected by POC-GM.…”

Section: Continuous Glucose Monitoringmentioning

confidence: 99%

Bridging technology and clinical practice: innovating inpatient hyperglycaemia management in non‐critical care settings

Thabit

Hovorka

2018

Diabet. Med.

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Emerging evidence shows that suboptimal glycaemic control is associated with increased morbidity and length of stay in hospital. Various guidelines for safe and effective inpatient glycaemic control in the non-critical care setting have been published. In spite of this, implementation in practice remains limited because of the increasing number of people with diabetes admitted to hospital and staff work burden. The use of technology in the outpatient setting has led to improved glycaemic outcomes and quality of life for people with diabetes. There remains an unmet need for technology utilisation in inpatient hyperglycaemia management in the non-critical care setting. Novel technologies have the potential to provide benefits in diabetes care in hospital by improving efficacy, safety and efficiency. Rapid analysis of glucose measurements by point-of-care devices help facilitate clinical decision-making and therapy adjustment in the hospital setting. Glucose treatment data integration with computerized glucose management systems underpins the effective use of decision support systems and may streamline clinical staff workflow. Continuous glucose monitoring and automation of insulin delivery through closed-loop systems may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia whilst reducing staff workload. This review summarizes the evidence with regard to technological methods to manage inpatient glycaemic control, their limitations and the future outlook, as well as potential strategies by healthcare organizations such as the National Health Service to mediate the adoption, procurement and use of diabetes technologies in the hospital setting.

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“…In this issue of Diabetes Technology & Therapeutics, Schaupp et al 9 present results from use of professional CGM in 84 hospitalized non-critically ill subjects undergoing insulin titration. They identified a large number of undetected hypoglycemic events, particularly overnight, and a substantial number of hyperglycemic events, most commonly between 6 a.m. to noon.…”

Section: Evidence For Inpatient Cgmmentioning

confidence: 99%

Continuous Glucose Monitoring Use in Hospitalized Patients

Dungan

2015

Diabetes Technology & Therapeutics

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Taking a Closer Look—Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus Under Basal-Bolus Insulin Therapy

Cited by 38 publications

References 30 publications

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Bridging technology and clinical practice: innovating inpatient hyperglycaemia management in non‐critical care settings

Continuous Glucose Monitoring Use in Hospitalized Patients

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