MON-576 - Continuous Glucose Monitoring Versus Standard Point of Care Blood Glucose Monitoring in the Cardiac Intensive Care Unit

Background: In-hospital hyperglycemia is associated with adverse outcomes including increased length of stay, infections, and mortality. While continuous glucose monitoring (CGM) is increasingly used in inpatient settings, its role in the cardiac intensive care unit (CICU) is not yet well studied. We evaluated the impact of CGM use compared to standard point-of-care blood glucose (POC-BG) monitoring in insulin-treated patients with diabetes in the CICU.

Methods: This single-center, exploratory randomized trial enrolled adults with diabetes who were admitted to the CICU and receiving ≥10 units/day of insulin. The Dexcom G7 was applied on all patients upon enrolment. Participants were randomized to either the unblinded CGM arm with enabled alarms, or the blinded CGM arm with silenced alarms. Participants in the blinded arm received standard of care with POC-BG monitoring. The primary outcome was hypoglycemic events. Secondary outcomes included time in range (TIR) defined as 70-180 mg/dL (3.9-10mmol/L), time above range (TAR) defined as >180 mg/dL (>10mmol/L), mean glucose, as well as accuracy and safety measures.

Results: Nine patients were enrolled, yielding 190 matched CGM-POC-BG pairs. Mean age was 61.7 ± 12.3 years. 67% were male, and all patients had type 2 diabetes. Baseline HbA1C was < 7.0% in 33% of patients and between 7.0-8.5% in 55.6% of patients.
CGM overall demonstrated excellent accuracy with median MARD of 6.2% (IQR 3.0, 12.1), preserved in hyperglycemic ranges (>250mg/dL, 13.9 mmol/L) as well at 5.6% (2.1, 10.8). 99.5% of matched pairs fell within Clarke Error Grid zones A or B.
No hypoglycemic events were observed. Mean glucose for the unblinded and blinded arm were 201.2 mg/dL (11.2 mmol/L) and 259.2 mg/dL (14.4 mmol/L), respectively. TIR and TAR were 22.0% (11.0, 29.0) and 77.0% (70.5, 88.5) for the blinded arm and 51.5% (35.0, 65.0) and 48.5% (34.2, 65.0) for the unblinded arm.

Conclusion: Our study demonstrates excellent CGM accuracy and safety across glycemic ranges including hyperglycemic levels, supporting its applicability in insulin-treated patients with diabetes in the CICU. Profound rates of hyperglycemia exceeding guideline targets of 140-180 mg/dL (7.7-10 mmol/L) and poor time in range were noted despite the absence of hypoglycemic events, suggesting that hyperglycemia rather than hypoglycemia may be the predominant challenge in real-world glycemic management in the CICU. These findings highlight the need for further investigation of CGM-guided strategies to improve inpatient glycemic management in this population.

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