DIAbetes TEam and Cgm in Managing Hospitalised Patients with Diabetes

NCT ID: NCT05803473

Last Updated: 2025-02-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

166 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-11

Study Completion Date

2024-07-29

Brief Summary

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This trial investigates the effects of continuous glucose monitoring (CGM) and an in-hospital diabetes team on in-hospital glycemic and clinical outcomes in patients with type 2 diabetes compared to standard glucose point-of-care (POC) testing and an in-hospital diabetes team.

Detailed Description

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In Denmark and worldwide, 15-20 % of hospitalised patients have diabetes mellitus. For most patients, diabetes is not the primary cause of admission. The patients are therefore under the care of non-diabetes specialists. Consequently, diabetes management can be inadequate resulting in hypoglycemia, hyperglycemia, and increased glycemic variability, which might increase patient mortality, morbidity, and length of hospital stay. Despite these challenges, a recent review concludes that in-hospital diabetes management is under-researched. Therefore, new in-hospital diabetes management strategies are greatly needed.

Continuous glucose monitoring (CGM) might accommodate this need by providing 288 glucose readings per day compared to usual glucose point-of-care (POC) testing from finger-prick blood 3-5 times per day during admission. CGM glucose levels can be transmitted from the patient's room to a monitoring screen at the nursing stations. This setup is called telemetric CGM. Outstanding results on glycemic and clinical outcomes in an out-hospital setting exist, however, In-hospital CGM has been associated only with a clinically insignificant reduction of mean daily glucose levels and a small increased detection rate of hypoglycemia of glucose levels \<3 mmol/L (\<54 mg/dL) compared to POC. Reasons for this might be that an in-hospital diabetes team (i.e., educated diabetes nurses with CGM competencies) is imperative in achieving optimal use of telemetric CGM.

This trial investigates if telemetric CGM and an in-hospital diabetes team improve patients' in-hospital glycemic and clinical outcomes compared to POC glucose testing and an in-hospital diabetes team

Conditions

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Diabetes Mellitus, Type 2

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is an investigator-initiated, two-site, prospective randomised open-label blinded endpoint (PROBE) trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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POC-arm

Subjects are monitored by point-of-care (POC) glucose testing. Diabetes management is done by usual ward nurses and guided by an in-hospital diabetes team. A blinded CGM is mounted in the POC-arm for outcome analysis.

Group Type ACTIVE_COMPARATOR

FreeStyle Precision Pro Glucometer for glucose POC testing

Intervention Type DEVICE

For the POC-arm subjects, glucose assessment is done by standard ward glucometer.

CGM-arm

CGM-arm subjects are monitored by CGM viewed by the in-hospital diabetes team in addition to POC glucose testing performed by usual ward nurses. Diabetes management is done by usual ward nurses by POC glucose testing and guided by an in-hospital diabetes team with acces to CGM data.

Group Type EXPERIMENTAL

Dexcom G6 Continuous Glucose Monitoring System (Dexcom Inc., San Diego, USA)

Intervention Type DEVICE

For CGM-arm subjects, glucose data are obtained by the CGM Dexcom G6 which via an iPhone SE 3 transmits data to the in-hospital diabetes team stations to be displayed on an iPad 9 10.2".

Interventions

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Dexcom G6 Continuous Glucose Monitoring System (Dexcom Inc., San Diego, USA)

For CGM-arm subjects, glucose data are obtained by the CGM Dexcom G6 which via an iPhone SE 3 transmits data to the in-hospital diabetes team stations to be displayed on an iPad 9 10.2".

Intervention Type DEVICE

FreeStyle Precision Pro Glucometer for glucose POC testing

For the POC-arm subjects, glucose assessment is done by standard ward glucometer.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* A documented history of T2DM prior to inclusion
* Age ≥ 18 years old
* Willingness and ability to comply with the clinical investigation plan
* Ability to communicate in Danish with the trial personnel
* An expected length of hospital stay for at least two days after enrolment
* If subject with childbearing potential (subject \< 50 years old); willing to have a urine pregnancy test performed and/or to use a highly effective method of contraception (i.e., birth control implant, intrauterine device, birth control shot, or sterilisation).

Exclusion Criteria

* Patients on out-hospital basal insulin with duration of action \> 24 hours (Toujeo or Tresiba)
* Treated with hydroxyurea/hydroxycarbamid
* Nutritional therapy (continuous enteral or parenteral feeding)
* Clinically relevant pancreatic disease
* Systemic glucocorticoid treatment with prednisone equivalent dose \>5 mg/day
* Expected to require admission to the intensive-care unit
* Anasarca (severe and general edema)
* Dialysis
* Estimated glomerular filtration rate (eGFR) \<15 mL/min/1.73 m2
* Known hypersensitivity to the band-aid of the CGM Dexcom G6 sensor.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Peter Kristensen

OTHER

Sponsor Role lead

Responsible Party

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Peter Kristensen

Medical Doctor, PhD, Clinical Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Peter Lommer Kristensen, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Copenhagen University Hospital - North Zealand, Department of Endocrinology and Nephrology, Denmark

Katrine Bagge Hansen, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Copenhagen University Hospital - Herlev-Gentofte, Steno Diabetes Center Copenhagen, Denmark

Locations

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Copenhagen University Hospital - Herlev-Gentofte (Steno Diabetes Center Copenhagen)

Herlev, , Denmark

Site Status

Copenhagen University Hospital - North Zealand

Hillerød, , Denmark

Site Status

Countries

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Denmark

References

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Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002 Mar;87(3):978-82. doi: 10.1210/jcem.87.3.8341.

Reference Type BACKGROUND
PMID: 11889147 (View on PubMed)

Kristensen PL, Jessen A, Houe SMM, Banck-Petersen P, Schiotz C, Hansen KB, Svendsen OL, Almdal T, Bjerre-Christensen U. Quality of diabetes treatment in four orthopaedic departments in the Capital Region of Denmark. Dan Med J. 2021 Nov 30;68(12):A05210449.

Reference Type BACKGROUND
PMID: 34851255 (View on PubMed)

Akiboye F, Sihre HK, Al Mulhem M, Rayman G, Nirantharakumar K, Adderley NJ. Impact of diabetes specialist nurses on inpatient care: A systematic review. Diabet Med. 2021 Sep;38(9):e14573. doi: 10.1111/dme.14573. Epub 2021 May 18.

Reference Type BACKGROUND
PMID: 33783872 (View on PubMed)

Swanson CM, Potter DJ, Kongable GL, Cook CB. Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011 Nov-Dec;17(6):853-61. doi: 10.4158/EP11042.OR.

Reference Type BACKGROUND
PMID: 21550947 (View on PubMed)

Thabit H, Hovorka R. Glucose control in non-critically ill inpatients with diabetes: towards closed-loop. Diabetes Obes Metab. 2014 Jun;16(6):500-9. doi: 10.1111/dom.12228. Epub 2013 Nov 24.

Reference Type BACKGROUND
PMID: 24267153 (View on PubMed)

Olsen MT, Dungu AM, Klarskov CK, Jensen AK, Lindegaard B, Kristensen PL. Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia. BMC Pulm Med. 2022 Mar 9;22(1):83. doi: 10.1186/s12890-022-01874-7.

Reference Type BACKGROUND
PMID: 35264139 (View on PubMed)

Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax. 2006 Apr;61(4):284-9. doi: 10.1136/thx.2005.051029. Epub 2006 Jan 31.

Reference Type BACKGROUND
PMID: 16449265 (View on PubMed)

Dhatariya KK, Umpierrez G. Gaps in our knowledge of managing inpatient dysglycaemia and diabetes in non-critically ill adults: A call for further research. Diabet Med. 2023 Mar;40(3):e14980. doi: 10.1111/dme.14980. Epub 2022 Nov 16.

Reference Type BACKGROUND
PMID: 36256494 (View on PubMed)

Klarskov CK, Windum NA, Olsen MT, Dungu AM, Jensen AK, Lindegaard B, Pedersen-Bjergaard U, Kristensen PL. Telemetric Continuous Glucose Monitoring During the COVID-19 Pandemic in Isolated Hospitalized Patients in Denmark: A Randomized Controlled Exploratory Trial. Diabetes Technol Ther. 2022 Feb;24(2):102-112. doi: 10.1089/dia.2021.0291. Epub 2022 Jan 4.

Reference Type BACKGROUND
PMID: 34524009 (View on PubMed)

Seisa MO, Saadi S, Nayfeh T, Muthusamy K, Shah SH, Firwana M, Hasan B, Jawaid T, Abd-Rabu R, Korytkowski MT, Muniyappa R, Antinori-Lent K, Donihi AC, Drincic AT, Luger A, Torres Roldan VD, Urtecho M, Wang Z, Murad MH. A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline for the Management of Hyperglycemia in Adults Hospitalized for Noncritical Illness or Undergoing Elective Surgical Procedures. J Clin Endocrinol Metab. 2022 Jul 14;107(8):2139-2147. doi: 10.1210/clinem/dgac277.

Reference Type BACKGROUND
PMID: 35690929 (View on PubMed)

Olsen MT, Klarskov CK, Pedersen-Bjergaard U, Hansen KB, Kristensen PL. Summary of clinical investigation plan for The DIATEC trial: in-hospital diabetes management by a diabetes team and continuous glucose monitoring or point of care glucose testing - a randomised controlled trial. BMC Endocr Disord. 2024 May 6;24(1):60. doi: 10.1186/s12902-024-01595-4.

Reference Type DERIVED
PMID: 38711112 (View on PubMed)

Other Identifiers

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2301240

Identifier Type: -

Identifier Source: org_study_id

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