908-P: Accuracy Comparison of the Freestyle Libre Pro Continuous Glucose Monitoring (CGM) and Point-of-Care (POC) Testing in Noncritically Ill Hospitalized Patients with Type 2 Diabetes Treated with Basal-Bolus Insulin Regimen

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).

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Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring

Diabetes Mellitus ◽

10.14341/dm2014175-80 ◽

2014 ◽

Vol 17 (1) ◽

pp. 75-80 ◽

Cited By ~ 6

Author(s):

Vadim Valer'evich Klimontov ◽

Alexander Ivanovich Tsiberkin ◽

Olga Nikolaevna Fazullina ◽

Marina Alekseevna Prudnikova ◽

Nadezhda Viktorovna Tyan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Insulin Regimen ◽

Premixed Insulin ◽

Dipeptidyl Peptidase 4 ◽

Retrospective Data Analysis ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Bolus Insulin

Aims. To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM) patients by means of continuous glucose monitoring (CGM). Materials and Methods. We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36), premixed insulin (n=12) or basal-bolus insulin regimen (n=28) was followed by metformin (n=44), glimepiride (n=14) and dipeptidyl peptidase-4 inhibitors (n=14). 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter. Results. Hypoglycemia (identified as blood glucose

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Taking a Closer Look—Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus Under Basal-Bolus Insulin Therapy

Diabetes Technology & Therapeutics ◽

10.1089/dia.2014.0343 ◽

2015 ◽

Vol 17 (9) ◽

pp. 611-618 ◽

Cited By ~ 17

Author(s):

Lukas Schaupp ◽

Klaus Donsa ◽

Katharina M. Neubauer ◽

Julia K. Mader ◽

Felix Aberer ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Insulin Therapy ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Bolus Insulin ◽

Basal Bolus

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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

10.2337/figshare.12302660.v1 ◽

2020 ◽

Cited By ~ 1

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

Background: 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). Methods: 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. Results: 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. Conclusions: 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.

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SAT-640 Glycemic Profile of Intravenous Glucocorticoid Induced Hyperglycemia Using Continuous Glucose Monitoring

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1010 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fan Zhang ◽

Zoe Goldberg ◽

Jocelyne Georges Karam

Keyword(s):

Type 2 Diabetes ◽

Single Dose ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Sensitivity Factor ◽

Insulin Regimen ◽

Freestyle Libre ◽

Glycemic Profile ◽

Long Acting

Abstract Background: Intravenous (IV) steroids are widely used in critically ill patients and with chemotherapy. It is well known that glucocorticoid-induced hyperglycemia (GCIH) occurs within 3 hours following oral administration of steroids with typical postprandial glycemic excursions lasting 24-36 hours. The recent increased availability of Continuous Glucose Monitoring (CGM) has allowed a detailed description of glycemic fluctuations in patients receiving steroids in different settings, however there is no reported observation of CGM findings following a single dose of IV Dexamethasone in a patient with diabetes. We present a case of glycemic pattern documented on CGM of a patient with type 2 diabetes, who had received 11 cycles of a single dose Dexamethasone-containing chemotherapy. Clinical Case: The patent is 70 years old female with history of type 2 DM of 19 years duration and metastatic pancreatic adenocarcinoma, diagnosed in November 2018, and treated with Fluorouracil and Dexamethasone 6mg IV on every other Wednesday since December 2018. Her diabetes was fairly controlled on Metformin, Repaglinide, Pioglitazone and Detemir insulin. Premeal Lispro was added while Metformin and Repaglinide were discontinued with the beginning of chemotherapy. She started using Freestyle Libre CGM in January 2019. During her visit in March 2019, the patient was taking Detemir Insulin 50 units in AM and 30 units at night, and Lispro 15 units before meals, in addition to correction insulin based on an Insulin Sensitivity Factor (ISF) of 1:25 for Blood Glucose (BG) above 200mg/dl. Unlike the reported postprandial hyperglycemic excursions associated with oral steroids, the patient’s CGM data showed a reproducible triphasic glycemic pattern following IV Dexamethasone, consisting of a steady state of hyperglycemia reached within 3 hours and lasting around 18-30 hours, followed by a transient BG improvement for 18-20 hours, and ending with another hyperglycemic plateau of 10-16 hours on day 3 post chemotherapy, with no association to meal intake. Given this recurrent pattern, the patient was advised to increase her bedtime Detemir insulin from 30 to 45 units and her correction ISF from 1:25 to 1:18 on days 1 and 2 after chemotherapy, with subsequent attenuation and shortening of GCIH. Conclusion: Our case report is the first one to describe CGM documented glycemic profile following a single dose of IV Dexamethasone in a patient with type 2 diabetes treated with insulin. The CGM data reveals a consistent steady GCIH, lasting around 48 hours, and reflecting the prolonged action of Dexamethasone. The transient BG improvement seen on day 2 is likely due to the Detemir dose self-increase and the carbohydrates intake decrease in response to day 1 hyperglycemia. A 48 hours modified insulin regimen based on higher dose of long acting and correction insulin improved Dexamethasone induced hyperglycemia.

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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

10.2337/figshare.12302660 ◽

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

Background: 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). Methods: 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. Results: 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. Conclusions: 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.

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