Glycemic Levels and Insulin Use Daily and During Hospital Shifts in Hospitalized Patients With Type 2 Diabetes

To characterize glucose levels and insulin use daily and during hospital shifts throughout hospitalization, which might inform treatment planning and improve outcomes.

This is a post hoc analysis from a 2-center randomized trial with 166 nonintensive care unit hospitalized patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing (POC arm) or continuous glucose monitoring (CGM arm). POC-arm participants wore blinded continuous glucose monitors. The primary outcome was the development in time in range (TIR) (3.9-10.0 mmol/L) between arms during hospitalization.

TIR improved progressively to nearly 90% in the CGM arm by discharge, compared to 60% in the POC arm, which plateaued after day 5 (P < .001). Both arms showed the lowest TIR and highest insulin use during the day shift (07:00-15:00 hours). Correctional insulin doses were lower in the CGM arm compared to the POC arm across all shifts: 0.7 IU (±0.3) lower during day shifts (07:00-15:00 hours, P = .016), 1.2 IU (±0.4) lower during evening shifts (15:01-23:00 hours, P = .005), and 0.3 IU (±0.1) lower during night shifts (23:01-06:59 hours, P = .038). Prandial insulin doses were 1.1 IU (±0.5) lower during evening shifts in the CGM arm (P = .021).

TIR improved continuously to nearly 90% in the CGM arm by discharge, compared to 60% in the POC arm, which plateaued after day 5, despite lower daily insulin doses in the CGM arm. These findings underscore the sustained effectiveness of CGM in enhancing glycemic levels throughout the entire duration of hospitalization.