Telemetric Continuous Glucose Monitoring During the COVID-19 Pandemic in Isolated Hospitalized Patients in Denmark: A Randomized Controlled Exploratory Trial

Abstract

Objective: To investigate whether telemetric continuous glucose monitoring (CGM) in hospitalized and isolated patients with diabetes mellitus and coronavirus disease 2019 (COVID-19) is associated with better glycaemic outcomes and fewer patient-health care worker contacts compared to blood glucose monitoring by traditional point-of-care (POC) glucose testing and to investigate the user aspect of implementing a CGM-system inhospital. Methods: A randomized controlled exploratory trial was performed on hospitalized and isolated patients with diabetes and COVID-19 from May 2020 until February 2021 at Nordsjaellands Hospital, Denmark. Participants were randomized to nonblinded telemetric CGM (as the only glucose monitoring method) or traditional POC glucose testing + blinded CGM. The primary endpoint was Time In Range (TIR) based on CGM data in both groups. A questionnaire about the user aspect of the CGM system was answered by health care personnel (HCP). Results: We included 64 participants in the analysis, 31 in the CGM group and 33 in the POC glucose group. TIR median was 46% for the CGM group and 68% for the POC glucose group (p=0.368). The mean glucose value for the CGM group was 11.1 mmol/L and 10.8 mmol/L in the POC glucose group (p=0.372). CGM was associated with fewer POC glucose measurements (p<0.001). Out of 30 HCPs, 28 preferred telemetric CGM over POC glucose testing. Conclusion: Remote glucose monitoring by CGM did not improve glycaemic outcomes compared to traditional POC glucose testing but was associated with fewer patientpersonnel contacts, saving time for HCPs performing diabetes-related tasks. Most HCPs preferred CGM.

Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia

“…The CGM sensors used in this study has an upper detection limit for glucose levels of 22.2 mmol/L (400 mg/ dL). Therefore, right-censored glucose values were estimated using a validated imputation model developed previously by authors [19]. A two-sided P-value ≤ 0.05 was considered statistically significant for all analyses.…”

“…1). This is worrying considering the ongoing pandemic where GCs are part of the treatment protocol for patients with COVID-19 [38], which could potentially induce great glycemic dysregulation especially in patients with diabetes [19] and prolong LOS and thereby increase work pressure on already overcrowded and stressed wards.…”

A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials

“…Although targets may be more difficult to achieve during acute illness, assessment of hospital %TIR can facilitate a longitudinal assessment of glycemic control during the hospitalization, and response to therapy. 13,14,[32][33][34] Although %TIR goals outlined below may be difficult to achieve in a subpopulation of patients depending on clinical factors and management regimen complexity, this approach highlights the need for individualization of %TIR goals. Standardization of this metric for defining ranges for research purposes might not apply to target glycemia for the care of individual patients.…”

“…The impact of using CGM for treatment decisions thus far has been modest on overall glycemic control based on recent clinical trials. 13,14,33 Two RCTs were suspended because of COVID-19 and were analyzed early but provided some insight about the performance of CGM in the hospital. 10,14 In patients with high risk for hypoglycemia the use of remote CGM with a specific protocol may reduce the number of hypoglycemic events.…”

Update on glucose control during and after critical illness

“…Whilst this novel method appeared precise, critically ill patients have a requirement for multiple IV therapies and adoption of this technique is likely to be hindered by the practical loss of a central venous catheter lumen solely dedicated to the monitoring of blood glucose. During the early phases of the COVID-19 pandemic, there was considerable enthusiasm to use near-CGM for 'remote' monitoring [14,15]. There are theoretical advantages of reducing needles and blood sampling in patients with a transmissible infection but the cost-effectiveness of implementing near-CGM in the ICU is unknown.…”