Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study.
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Hirsch Irl B, Draznin Boris, Buse John B, Raghinaru Dan, Spanbauer Charles, Umpierrez Guillermo E, Ullal Jagdeesh, Jones Morgan S, Low Wang Cecilia C, Spanakis Elias K, Chao Jing H, Sibayan Judy, Kollman Craig, Zabala Zohyra E, Moazzami Bobak, Reynolds Shari L, Ferrara Wanda, Fulghum Karla, Kass Alex, Armstrong Chase, Gilani Faryal, Seggelke Stacey, Churchill Jade, Monye Joseph O, Choe Monica Y, Scott William, Baran Jesica D, Bais Rajlaxmi, Khakpour Dori, Pasquel Francisco J, Davis Georgia M, Vellanki Priyathama, Kershaw Erin E, Gligorijevic Nikola, Goley April, Garg Avni, Alexander Bonnie, Matson Brooke C, Diner Jamie, Klein Klara R, Adair Whitney B, Choksi Palak, Huang Michelle, Vinh Jennifer, Singh Lakshmi G, Beck Roy W, TIGHT RCT Study Group
Аннотация
RESEARCH DESIGN AND METHODS: At six academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with glucose target 140-180 mg/dL (standard group) or intensive therapy with glucose target 90-130 mg/dL guided by CGM (intensive group). The primary outcome was mean glucose measured with CGM (blinded in standard group), and the key secondary outcome was CGM glucose <54 mg/dL.
RESULTS: For the 110 participants included in the primary analysis, mean ± SD age was 61 ± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL for the intensive group (n = 60) vs. 175 mg/dL for the standard group (n = 50; risk-adjusted difference -7 mg/dL, 95% CI -19 to 5; P = 0.25). Only 7% of the intensive group achieved the mean glucose target range of 90-130 mg/dL. CGM readings <54 mg/dL were infrequent (0.2% for intensive and 0.4% for standard; adjusted treatment group difference -0.1%, 95% CI -0.6 to 0.3). One severe hypoglycemia event occurred in the standard group.
CONCLUSIONS: The study's glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non-intensive care unit hospital setting. A glucose target of 90-130 mg/dL may not be realistic in the current environment of insulin management in the hospital.