Continuous Glucose Monitoring-Guided Insulin Administration in Long-Term Care Facilities: A Randomized Clinical Trial.
Thaer Idrees, Iris A Castro-Revoredo, Hyungseok D Oh and 10 others
PMID 38460943WHAT IT FOUND
Real-time continuous glucose monitoring with remote monitoring and alarms did not improve time with glucose in target range compared with standard fingerstick testing in long-term care residents on insulin.
It did detect more low and high glucose events than fingersticks.
Key findings
01The CGM group did not significantly improve the primary outcome, time with glucose between 70 and 180 mg/dL, compared with the POC group.
02CGM detected a greater proportion of participants with glucose below 70 mg/dL, below 54 mg/dL, and above 250 mg/dL than POC testing.
03Time with glucose below 70 mg/dL and below 54 mg/dL did not differ significantly between groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 97 residents were analyzed after 3 CGM participants had less than 7 days of data, so the study is small. All participants came from one academic institution, mostly subacute rehabilitation units, so results may not apply to all long-term care settings. Only the Dexcom G6 real-time CGM was tested, so findings may not apply to other CGM devices. Follow-up was short, with participants followed for a minimum of 10 days and up to 60 days. Clinical care was supported by internal medicine providers, endocrinology and research teams, so ordinary facility staffing may differ. The intervention included CGM, remote monitoring, alarms, nursing confirmation, and provider insulin adjustments, so the study cannot identify which component mattered.
Declared interests
The supplied metadata lists research support, non-U.S. government and N.I.H., extramural. The article text does not provide an author conflict-of-interest declaration.
The easy way to misread this
Do not conclude that real-time continuous glucose monitoring with remote monitoring and alarms improves glycemic control or prevents hypoglycemia. The primary time-in-range outcome was not significantly different, and time with low glucose did not differ significantly, even though CGM detected more glucose events.