Enhanced Detection of Adverse Glycemic Events in Hospital with Unmasked Continuous Glucose Monitoring Versus...

In people with type 1 diabetes (T1D) admitted to hospital, adverse glycemic events (AGE), both hypoglycemia and hyperglycemia, bestow risk for adverse outcomes. Continuous glucose monitoring (CGM) use is increasingly common amongst people with T1D. We investigated AGE frequency in hospital, based on CGM versus point-of-care (POC) blood glucose measures.

In this multi-center retrospective analysis of non-critically ill hospitalized adults with T1D who continued wearing their unmasked CGM (FreeStyle Libre 1/2, Dexcom G5/G6, Medtronic Guardian 3) during admission and received standard ward-based POC testing, we compared CGM- and POC-based AGE detection of hypoglycemia (<70 mg/dL) and hyperglycemia (>180 mg/dL).

In 253 admissions, 127 837 CGM and 5508 POC glucose measures were analyzed, yielding 1391 CGM-detected hyperglycemia AGE and 317 CGM-detected hypoglycemia AGE. For CGM-detected AGE with a concurrent POC AGE evident, CGM detected hyperglycemia a median [interquartile range, IQR] of 70 minutes [22, 166] before POC and at lower glucose concentrations (187 vs 223 mg/dL, P < .0001) and detected hypoglycemia a median [IQR] of 38 minutes [14, 65] before POC and at higher glucose concentrations (67 vs 56 mg/dL, P < .0001). A quarter of CGM-detected AGE were not detected by POC. Only 3% of POC-detected AGE were not detected by CGM.

Almost all AGE in hospital were detected by CGM, with few detected by POC alone. Compared to POC, CGM detected AGE earlier, with a lesser glycemic extreme, although unmasked CGM use may have influenced these results. Detecting AGE in hospital appears superior with CGM compared to POC glucose alone in people with T1D.