In-Hospital Diabetes Management by a Diabetes Team and Insulin Titration Algorithms Based on Continuous Glucose Monitoring or Point-of-Care Glucose Testing in Patients With Type 2 Diabetes (DIATEC): A Randomized Controlled Trial.

Summary

In this two-center randomized trial of 166 hospitalized adults with type 2 diabetes, CGM-guided insulin titration increased time-in-range by 15 percentage points versus point-of-care guidance, and reduced time above range, time below range, glycemic variability, prolonged hypoglycemia, insulin dose, and a composite of complications. The findings support CGM-guided protocols for inpatient diabetes management.

Key Findings

• CGM arm achieved higher median TIR: 77.6% vs 62.7% (P<0.001).
• Time above range >10.0 mmol/L was lower with CGM: 21.1% vs 36.5% (P=0.001).
• Time below range <3.9 mmol/L reduced with CGM (relative difference 0.57; 95% CI 0.34-0.97; P=0.042) and prolonged hypoglycemia events decreased (IRR 0.13; P=0.001).
• Glycemic variability (coefficient of variation) was lower with CGM: 25.4% vs 28.0% (P=0.024).
• Total daily insulin dose was reduced (24.1 vs 29.3 IU/day; P=0.049), and composite in-hospital complications were lower (IRR 0.76; P=0.032).

Clinical Implications

Hospitals should consider implementing CGM-based insulin titration algorithms for non-ICU inpatients with type 2 diabetes, supported by diabetes teams, to improve glycemic control and reduce complications and insulin requirements.

Limitations

• Conducted in non-ICU settings at two centers; generalizability to ICU or different hospital systems may be limited.
• Short assessment window restricted to hospitalization; no post-discharge outcomes reported.

Future Directions

Evaluate scalability, cost-effectiveness, and implementation strategies for CGM-guided inpatient insulin titration across diverse hospital systems, including ICU settings and post-discharge outcomes.