Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA, USA.
Division of Geriatrics, and Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
J Am Med Dir Assoc. 2024 May;25(5):884-888. doi: 10.1016/j.jamda.2024.01.031. Epub 2024 Mar 6.
To evaluate the efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF).
Prospective randomized clinical trial.
Insulin-treated patients with type 2 diabetes (T2D) admitted to LTCF.
Participants in the standard of care wore a blinded CGM with treatment adjusted based on point-of-care capillary glucose results before meals and bedtime (POC group). Participants in the intervention (CGM group) wore a Dexcom G6 CGM with treatment adjusted based on daily CGM profile. Treatment adjustment was performed by the LTCF medical team, with a duration of intervention up to 60 days. The primary endpoint was difference in time in range (TIR 70-180 mg/dL) between treatment groups.
Among 100 participants (age 74.73 ± 11 years, 80% admitted for subacute rehabilitation and 20% for nursing home care), there were no significant differences in baseline clinical characteristics between groups, and CGM data were compared for a median of 17 days. There were no differences in TIR (53.38% ± 30.16% vs 48.81% ± 28.03%, P = .40), mean daily mean CGM glucose (184.10 ± 43.4 mg/dL vs 190.0 ± 45.82 mg/dL, P = .71), or the percentage of time below range (TBR) <70 mg/dL (0.83% ± 2.59% vs 1.18% ± 3.54%, P = .51), or TBR <54 mg/dL (0.23% ± 0.85% vs 0.56% ± 2.24%, P = .88) between rt-CGM and POC groups.
The use of rtCGM is safe and effective in guiding insulin therapy in patients with T2D in LTCF resulting in a similar improvement in glycemic control compared to POC-guided insulin adjustment.
评估实时连续血糖监测（rt-CGM）在长期护理机构（LTCF）调整胰岛素治疗中的疗效。
前瞻性随机临床试验。
LTCF 中接受胰岛素治疗的 2 型糖尿病（T2D）患者。
接受标准护理的参与者佩戴盲法 CGM，餐前和睡前根据即时血糖仪（POC）结果调整治疗（POC 组）。接受干预（CGM 组）的参与者佩戴 Dexcom G6 CGM，根据每日 CGM 谱调整治疗。治疗调整由 LTCF 医疗团队进行，干预时间最长可达 60 天。主要终点是治疗组之间时间在目标范围内（TIR 70-180mg/dL）的差异。
在 100 名参与者（年龄 74.73±11 岁，80%因亚急性康复而入院，20%因疗养院护理而入院）中，两组间基线临床特征无显著差异，CGM 数据中位数比较了 17 天。TIR（53.38%±30.16%与 48.81%±28.03%，P=.40）、平均每日平均 CGM 血糖（184.10±43.4mg/dL 与 190.0±45.82mg/dL，P=.71）或低于目标范围的时间百分比（TBR）<70mg/dL（0.83%±2.59%与 1.18%±3.54%，P=.51）或 TBR<54mg/dL（0.23%±0.85%与 0.56%±2.24%，P=.88）在 rt-CGM 和 POC 组之间均无差异。
rtCGM 用于指导 LTCF 中 T2D 患者的胰岛素治疗是安全有效的，与 POC 指导的胰岛素调整相比，血糖控制得到了相似的改善。
