scholarly journals Comparison of the FreeStyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients With Type 2 Diabetes (T2D) Treated With Basal-Bolus Insulin Regimen

Diabetes Care ◽  
2020 ◽  
pp. dc192073 ◽  
Author(s):  
Rodolfo J. Galindo ◽  
Alexandra L. Migdal ◽  
Georgia M. Davis ◽  
Maria A. Urrutia ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Insulin Regimen ◽  
Glucose Testing ◽  
Freestyle Libre ◽  
Capillary Glucose ◽  
Bolus Insulin ◽  
Basal Bolus

scholarly journals Hypoglycemia Incidence and Factors Associated in a Cohort of Patients With Type 2 Diabetes Hospitalized in General Ward Treated With Basal Bolus Insulin Regimen Assessed by Continuous Glucose Monitoring

2019 ◽  
Vol 14 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Ana María Gómez ◽  
Angélica Imitola Madero ◽  
Diana Cristina Henao Carrillo ◽  
Martín Rondón ◽  
Oscar Mauricio Muñoz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
General Ward ◽  
Insulin Regimen ◽  
Factors Associated ◽  
Bolus Insulin ◽  
Mean Glucose ◽  
Basal Bolus

Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L).

scholarly journals Comparison of the Freestyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients with Type 2 Diabetes (T2D) Treated with Basal-Bolus Insulin Regimen

2020 ◽  
Author(s):  
Rodolfo J. Galindo ◽  
Alexandra L. Migdal ◽  
Georgia M. Davis ◽  
Maria A. Urrutia ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Glucose Testing ◽  
Grid Analysis ◽  
Freestyle Libre ◽  
Error Grid

<b>Background:</b> We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care glucose testing among insulin-treated hospitalized patients with type 2 diabetes (T2D). <p> </p> <p><b>Methods:</b> Prospective study in general medicine and surgery adult patients with T2D. Patient were monitored with POC before meals and bedtime, and with CGM during the hospital stay. Major endpoints included differences between POC and CGM in mean daily blood glucose, hypoglycemia < 70 and < 54 mg/dl, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), and ±15%/15mg/dl, ±20%/20mg/dl, ± 30%/30mg/dl, and Error Grid analysis between matched glucose pairs. </p> <p> </p> <p><b>Results</b>: Mean daily glucose was significantly higher by POC testing (188.9±37.3 vs. 176.1±46.9 mg/dl), and proportions of patients with glucoses < 70 mg/dl (14% vs 56%) and < 54 mg/dl (4.1% vs 36%) detected by POC BG were significantly lower compared to CGM, all p<0.001. Nocturnal and prolonged CGM hypoglycemia < 54 mg/dl was 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4 to 16.7% for glucoses between 70 and 250 mg/dl, and lower for 51- 69 mg/dL (MARD= 28.0%). The percentage of glucoses within the ±15%/15mg/dl, ±20%/20mg/dl, and ±30%/30mg/dl were 62%, 76%, and 91%, respectively. Error Grid analysis showed 98.0% of glucose pairs within Zones A and B. </p> <p><b> </b></p> <p><b>Conclusions</b>: Compared to POC testing, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM’s accuracy was lower in hypoglycemic range. </p>

scholarly journals Comparison of the Freestyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients with Type 2 Diabetes (T2D) Treated with Basal-Bolus Insulin Regimen

2020 ◽  
Author(s):  
Rodolfo J. Galindo ◽  
Alexandra L. Migdal ◽  
Georgia M. Davis ◽  
Maria A. Urrutia ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Glucose Testing ◽  
Grid Analysis ◽  
Freestyle Libre ◽  
Error Grid

<b>Background:</b> We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care glucose testing among insulin-treated hospitalized patients with type 2 diabetes (T2D). <p> </p> <p><b>Methods:</b> Prospective study in general medicine and surgery adult patients with T2D. Patient were monitored with POC before meals and bedtime, and with CGM during the hospital stay. Major endpoints included differences between POC and CGM in mean daily blood glucose, hypoglycemia < 70 and < 54 mg/dl, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), and ±15%/15mg/dl, ±20%/20mg/dl, ± 30%/30mg/dl, and Error Grid analysis between matched glucose pairs. </p> <p> </p> <p><b>Results</b>: Mean daily glucose was significantly higher by POC testing (188.9±37.3 vs. 176.1±46.9 mg/dl), and proportions of patients with glucoses < 70 mg/dl (14% vs 56%) and < 54 mg/dl (4.1% vs 36%) detected by POC BG were significantly lower compared to CGM, all p<0.001. Nocturnal and prolonged CGM hypoglycemia < 54 mg/dl was 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4 to 16.7% for glucoses between 70 and 250 mg/dl, and lower for 51- 69 mg/dL (MARD= 28.0%). The percentage of glucoses within the ±15%/15mg/dl, ±20%/20mg/dl, and ±30%/30mg/dl were 62%, 76%, and 91%, respectively. Error Grid analysis showed 98.0% of glucose pairs within Zones A and B. </p> <p><b> </b></p> <p><b>Conclusions</b>: Compared to POC testing, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM’s accuracy was lower in hypoglycemic range. </p>

scholarly journals Efficacy And Safety of Empagliflozin Continuation in Patients With Type 2 Diabetes Hospitalised For Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Luis M Pérez-Belmonte ◽  
Michele Ricci ◽  
Jaime Sanz-Cánovas ◽  
Mercedes Millán-Gómez ◽  
Julio Osuna-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Urine Output ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Insulin Regimen ◽  
Propensity Matching ◽  
Bolus Insulin ◽  
Basal Bolus

Abstract Background: Sodium−glucose cotransporter 2 inhibitors have been shown to reduce hospitalisations for acute decompensated heart failure in patients with and without type 2 diabetes. However, there is little evidence on their use in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure.Methods: This real-world study included non-critically ill patients with diabetes hospitalised for acute decompensated heart failure and treated with empagliflozin for at least three months prior to the hospitalisation between 2017 and 2020. According to our in-hospital antihyperglycaemic protocol, patients could be treated with two possible regimens: a basal-bolus insulin regimen and an empagliflozin-basal insulin regimen. Our primary endpoints were difference in glycaemic control, as measured via mean daily blood glucose level, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. The probability of starting the regimes was estimated with a logistic regression model including variables that could have affected treatment assignment or outcomes as independent variablesResults: After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs 155.2 ± 19.7 mg/dl, p=0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1,652 ± 501 vs 2,101 ± 522 pg/mL, p=0.032 and 16,100 ± 1,510 vs 13,900 ± 1,220 ml, p=0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs 64, p<0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths.Conclusions: For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.

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