Glycaemic levels and insulin use daily and during hospital shifts in hospitalised patients with type 2 diabetes

Objective To characterise glucose levels and insulin use daily and during hospital shifts throughout hospitalisation which might inform treatment planning and improve outcomes. Methods This is a posthoc analysis from a two-centre randomised trial with 166 non-intensive care unit hospitalised patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing (POC-arm) or continuous glucose monitoring (CGM-arm). POC-arm participants wore blinded CGMs. The primary outcome was the development in time in range (TIR) (3.9–10.0 mmol/l) between arms during hospitalisation. Results TIR improved progressively to nearly 90% in the CGM-arm by discharge, compared to 60% in the POC-arm, which plateaued after day 5 (p<.001). Both arms showed the lowest TIR and highest insulin use during the day shift (07:00–15:00 h). Correctional insulin doses were lower in the CGM-arm compared to the POC-arm across all shifts: 0.7 IU (±0.3) lower during day shifts (p=.016), 1.2 IU (±0.4) lower during evening shifts (15:01–23:00 h, p=.005), and 0.3 IU (±0.1) lower during night shifts (23:01–06:59 h, p=.038). Prandial insulin doses were 1.1 IU (±0.5) lower during evening shifts in the CGM-arm (p=.021). Conclusions TIR improved to nearly 90% in the CGM-arm by discharge, compared to 60% in the POC-arm, which plateaued after day 5, despite lower daily insulin doses in the CGM-arm. These findings underscore the sustained effectiveness of CGM in enhancing glycaemic levels throughout the entire duration of hospitalisation.