Key takeaways from the TIGHT study presented at the ADA Scientific Sessions:
- CGM did not improve glycemic control for hospitalized adults with type 2 diabetes.
- Patients with HbA1c >9% faced challenges in glucose management.
- Dexcom G6 and G7 Continuous Glucose Monitors (CGMs) showed comparable glucose monitoring results.
- Hypoglycemia rates were low across both intensive and standard glucose management groups.
- CGM benefits were noted for patients with HbA1c <9%, emphasizing its potential in specific hospital settings.
CGM in Hospitals: TIGHT Study Finds Limited Benefits
Orlando — The TIGHT study’s findings suggest that improving glycemic control for persons with type 2 diabetes by including continuous glucose monitoring into hospital standard of care is not likely to be beneficial. “There has been little research on strict glucose regulation in inpatients. According to Boris Draznin, MD, PhD, a visiting clinical professor of medicine at the University of Colorado School of Medicine, during a presentation at the American Diabetes Association Scientific Sessions, “there were several papers during the COVID period, but they were primarily addressing safety of interaction between staff and patients, rather than impact of glycemic level on the outcome of patients’ hospitalization.
TIGHT Study Examines Inpatient Challenges
“Given a range of challenges in inpatient settings, mostly associated with insulin injection, meal scheduling, and dietary unpredictability, we conducted an appropriate outcome trial utilizing Continuous Glucose Monitors to ascertain the efficacy, feasibility, and safety of Continuous Glucose Monitors use in non-ICU settings.” An investigator-initiated multicenter randomized parallel-group experiment, known as the TIGHT study, involved 110 persons from six academic institutions with glycemic management teams who had an HbA1c of more than 7% or type 2 diabetes. After the first 24 hours of randomization, participants were required to have at least one blood glucose reading of greater than 180 mg/dL, insulin started or scheduled, an anticipated non-ICU hospital stay longer than three days, and at least 12 hours of continuous glucose monitoring data.
CGM Study: Intensive vs. Standard Targets
- Researchers divided the 110 patients (mean age, 61 years) into two groups at random: the intensive target group (n = 60; 57% white), where the glucose management team used real-time Continuous Glucose Monitors to monitor glucose with a target concentration of 90 mg/dL to 130 mg/dL; or the standard target group (n = 50; 64% white), where the patients wore a masked CGM sensor and the glucose management team followed hospital standard procedure by using insulin with a target of 140 mg/dL to 180 mg/dL.
- An identification of bias led to the adoption of Dexcom G6 Continuous Glucose Monitors (CGMs) before moving to G6 Pro. Upon the release of G7 Continuous Glucose Monitors (CGMs), patients were converted to them.
- The mean glucose level and percentage of time below 54 mg/dL were the primary outcomes.
In general, the groups’ HbA1c levels, diabetes-related traits, and patient demographics were comparable. The HbA1c was 8.9% on average. For 40% of patients in the intensive group and 44% of patients in the normal group, infection was the most frequent cause of hospital admission.
There was no difference in the mean glucose levels between the intensive group (170 mg/dL) and the standard group (175 mg/dL). Mean glucose levels ranged from 90 to 130 mg/dL in 7% of participants in the intensive group and 6% in the regular group. In the intensive group, 48% and 33% of patients had glucose levels between 140 and 180 mg/dL, while in the standard group, 32% and 52% of patients had glucose levels above 180 mg/dL.
CGM Study: Glucose Control Findings
There was no discernible difference in the times in the range of 70 mg/dL to 180 mg/dL, 70 mg/dL to 140 mg/dL, more than 180 mg/dL, and more than 250 mg/dL between the intensive and conventional groups. The intensive group experienced a low rate of hypoglycemia, at 0.2%, while the conventional group experienced 0.4%. The three categories for HbA1c readings were less than 7.5%, 7.5% to 9%, and greater than 9%. The mean glucose levels of the intensive group participants with a HbA1c of less than 7.5% and 7.5% to 9% were 155 mg/dL and 166 mg/dL, respectively. These values were lower than the standard group’s observed values of 170 mg/dL and 182 mg/dL. Regardless of treatment group, patients with a HbA1c higher than 9% had more difficulty controlling their blood sugar, according to the study.
CGM Conversion and Glucose Levels
Researchers found that when patients converted from the G6 to the G7 Continuous Glucose Monitors (CGMs), there was no discernible change in blood glucose levels.
“As medical professionals, this is something we need to remember,” stated Guillermo Umpierrez, MD, a professor of medicine at Emory University School of Medicine’s Division of Endocrinology. “You have an advantageous effect of the CGM and intensive glycemic control in those patients admitted with an HbA1c less than 9%.”
Explore More Continuous Glucose Monitors Use in Type 2 Diabetes: ADA 84th Session Insights
FAQs
Which clinical implications from the study did Dr. Guillermo Umpierrez highlight?
In hospitalized patients with HbA1c values below 9%, Dr. Umpierrez stressed the advantages of strict glycemic management and continuous glucose monitoring.
What happened to patients who switched from G6 to G7 Continuous Glucose Monitors devices?
In the course of the trial, blood glucose levels did not significantly change as patients transitioned from the G6 to the G7 CGM devices.
How did the study’s results for glucose control relate to HbA1c levels?
In comparison to the conventional care group (170 mg/dL and 182 mg/dL), participants with HbA1c levels below 7.5% and between 7.5% to 9% in the intensive CGM group had lower mean glucose levels (155 mg/dL and 166 mg/dL, respectively).
What percentage of participants in the TIGHT study had hypoglycemia?
Hypoglycemia rates were low in the trial, 0.2% in the group receiving intensive Continuous Glucose Monitors and 0.4% in the group receiving standard treatment.
What were the primary conclusions of the TIGHT study about the usage of CGM in hospital environments?
Researchers discovered that there was no discernible difference in glucose levels between the intensive and routine care groups when utilizing Continuous Glucose Monitors within the designated ranges (70-180 mg/dL, 70-140 mg/dL, >180 mg/dL, >250 mg/dL).
