Assessing the Effectiveness of Continuous Glucose Monitoring in Enhancing Surgical Outcomes for Patients with Diabetes

NCT ID: NCT06331923

Last Updated: 2025-03-27

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

RECRUITING

Clinical Phase

NA

Total Enrollment

10168 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-04-12

Study Completion Date

2025-12-31

Brief Summary

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The goal of this multi-center, pragmatic, randomized controlled trial is to assess the effectiveness of continuous glucose monitoring (CGM) compared with conventional monitoring in enhancing surgical outcomes for diabetic patients. The main questions it aims to answer are:

* To assess the effectiveness of CGM compared with conventional monitoring in reducing the comprehensive complication index (CCI) for patients with diabetes or impaired glucose tolerance (IGT) within 30 days after surgery.
* To analyze the impact of different age groups, types of surgery, preoperative levels of HbA1c, and preoperative 24h glycemic variations on the improvement of surgical outcomes under the CGM model.

Participants will receive CGM prescribed by the attending physician for at least 6 hours before surgery. Glucose monitoring should be continued until the 7th day after surgery or discharge.

The investigators will compare conventional monitoring group to see if CGM could reduce the CCIs for patients with diabetes or impaired glucose tolerance within 30 days after surgery.

Detailed Description

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Abstract: Postoperative complications are important factors in reducing surgical quality and increasing healthcare costs. The CCI is an internationally recognized index to quantify postoperative complications. Patients with diabetes mellitus (DM) or IGT are more prone to developing dysglycemia during the perioperative period, which in turn leads to various types of complications and increased mortality, as evidenced by a significant increase in CCI. Our previous study confirmed that strict glucose management in the perioperative period can help reduce the incidence of postoperative complications such as surgical site infections (SSIs), but this strategy has not been replicated in the perioperative period due to the disadvantages of heavy and complex operations and the possible increased risk of concomitant hypoglycemia. CGM, with its advantages of portability, accuracy, real-time, and information-richness, has been used for precise glucose management in chronic diseases. A small number of prospective randomized controlled studies have previously demonstrated the existence of an improved effect of CGM on intraoperative glycemic management in major surgery. However, there are no real-world studies with large sample sizes to clarify the efficacy and safety of CGM in reducing CCI in patients with DM or IGT. This is where our research comes in. In this real-world study, we aim to clarify the role of perioperative CGM in improving both prognosis and efficacy of surgery.

This is an investigator-initiated, multi-center, pragmatic,1:1ratio randomized, parallel-group, controlled trial which consisted of a 1 to 3-day screening period, and a 7-day(at least 3-day) intervention period, with a final evaluation at day 30. A total of approximately 10168 patients (≥ 18 years of age) with DM or IGT undergoing elective surgeries (including major thoracoabdominal surgery \[excluding cardiac surgery\], open orthopedic surgery, or neurosurgery) will be enrolled. Patients fulfilling all of the inclusion criteria and none of the exclusion criteria will be randomized into two groups (CGM group versus C group) according to the 1:1 ratio after offering informed content.

Glucose monitoring models:

1. CGM group: A CGM prescription will be issued by the attending physician at least 6 hours before surgery. The primary nurse in charge will educate the participant and their family members on the proper wearing and connection of the CGM device. The calibration frequency and interval of preoperative and postoperative glucose monitoring devices will be determined based on institutional diagnostic and treatment guidelines and the requirements of the monitoring device used. Intraoperative glucose calibration will be performed immediately upon admission, immediately after surgical incision, every 2 hours after surgical incision, and at the completion of wound closure.
2. C group: Perioperative glucose monitoring will be conducted based on institutional diagnostic and treatment guidelines.
3. Glucose/blood glucose monitoring will be continued for both groups of patients until postoperative day 7 or discharge.

Perioperative glucose management:

1. Preoperatively: For elective surgery, preoperative fasting blood glucose/glucose ≤10 mmol/L and HbA1c≤7.0%. For emergency surgery, the decision whether the participant's current blood glucose level is acceptable for surgical treatment is based on institutional practice and the experience of the physician in charge.
2. Intraoperatively: Blood glucose level will be set at 4.5-10mmol/L. Participants in both groups will be given glucose to elevate blood glucose when blood glucose was found to be≤4.5 mmol/L, or insulin when blood glucose was found to be ≥10 mmol/L. Drug dosages and administration methods will follow the medical practice of the institution and the anaesthesiologist in charge. In the CGM group, if mean amplitude of glycemic excursions (MAGE) ≥3.9 mmol/L or largest amplitude of glycemic excursions (LAGE)≥4.4 mmol/L was found in the last 2 h, the dose or rate of glucose/insulin administration will be adjusted as appropriate.
3. Postoperatively: The target of blood glucose management in the early postoperative period is 4.5-7.8 mmol/L. According to the institutional practice and the supervising physician's experience, participants in both groups will be treated with glucose to elevate blood glucose when blood glucose was found to be ≤4.5 mmol/L, and will be treated with insulin to lower blood glucose when blood glucose was found to be ≥7.8 mmol/L.In the CGM group, if excessive blood glucose variability was found, including coefficient of variation (CV)≥36%, LAGE≥4.4 mmol/L, postprandial glucose excursions of three dinners (PPGE)≥2.2mmol/L, standard deviation of blood glucose (SDBG)≥2.0 mmol/L or time in range (TIR)≤70%, an endocrinologist will aid in adjusting the blood glucose management programme.

The primary objective is to observe the improvement of CGM on the surgical outcomes of participants with DM or IGT, including a reduction in the CCI, overall postoperative infection rate, major adverse cardiovascular events (MACE) rate, and shortened postoperative hospital stay within 30 days after surgery.

The study consists of 9 visits including the day of screening and randomization,1,2,3,4,5,6,7 and 30-day follow-up postoperatively.

Demographic information, symptoms and signs, laboratory test, auxiliary examinations, CCIs will be recorded during the program. The trial is anticipated to last from April 2024 to December 2025 with 10168 subjects recruited from 50 centers in China. All the related investigative organization and individuals will obey the Declaration of Helsinki and Chinese Good Clinical Practice standard. A Data and Safety Monitoring Board (DSMB) will regularly monitor safety during the study. The trial has been approved by the ethics committee of Beijing Tsinghua Chang Gung Hospital and corresponding branch centers.

Conditions

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Comprehensive Complication Index

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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CGM group

Participants who receive continuous glucose monitoring (CGM) during the perioperative period. Glucose monitoring should be continued until the 7th day after surgery or discharge.

Group Type EXPERIMENTAL

Continuous glucose monitoring (CGM) device

Intervention Type DEVICE

Continuous glucose monitoring (CGM) will be prescribed by the attending physician for at least 6 hours before surgery. The supervising nurse will educate the patient and their family on the correct wearing and connection of the CGM device. The calibration frequency and interval of glucose monitoring devices before and after surgery should be determined according to institutional treatment guidelines and the requirements of the monitoring device used. Intraoperative glucose calibration should be done immediately upon entering the operating room, immediately after skin incision, every 2 hours after skin incision, and at the end of wound closure. Glucose monitoring should be continued until the 7th day after surgery or discharge.

Control group

Perioperative blood glucose monitoring was performed according to institutional treatment guidelines.Glucose monitoring should be continued until the 7th day after surgery or discharge.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Continuous glucose monitoring (CGM) device

Continuous glucose monitoring (CGM) will be prescribed by the attending physician for at least 6 hours before surgery. The supervising nurse will educate the patient and their family on the correct wearing and connection of the CGM device. The calibration frequency and interval of glucose monitoring devices before and after surgery should be determined according to institutional treatment guidelines and the requirements of the monitoring device used. Intraoperative glucose calibration should be done immediately upon entering the operating room, immediately after skin incision, every 2 hours after skin incision, and at the end of wound closure. Glucose monitoring should be continued until the 7th day after surgery or discharge.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Patients aged above 18 years;
2. Patients with diabetes mellitus or impaired glucose tolerance;
3. Expected major thoracic and abdominal surgery (except cardiac surgery; including endoscopic surgery and robotic surgery), open orthopedic surgery, neurosurgery;
4. Volunteered for this study and written informed consent.

Exclusion Criteria

1. The patient refused;
2. The time between wearing CGM sensor and surgical skin incision cannot meet 6 hours or more;
3. Expected monitoring time less than 72 hours in CGM group;
4. Patients had comorbidities that affected the evaluation of endpoints;
5. The attending physician thought that the patient had inappropriate indications for enrollment;
6. Participants were involved in other studies that interfered with the evaluation of the results of this study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Peking University International Hospital

OTHER

Sponsor Role collaborator

Wang Jing Hospital

OTHER

Sponsor Role collaborator

ZhuHai Hospital

OTHER

Sponsor Role collaborator

Beijing Hospital

OTHER_GOV

Sponsor Role collaborator

Siyang County Hospital of Traditional Chinese Medicine

UNKNOWN

Sponsor Role collaborator

Second Hospital of Shanxi Medical University

OTHER

Sponsor Role collaborator

Henan Provincial Chest Hospital

OTHER

Sponsor Role collaborator

Fuzhou First Hospital

UNKNOWN

Sponsor Role collaborator

Pinggu Hospital of Beijing Traditional Chinese Medicine Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Anhui University of Chinese Medicine

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Zhengzhou University

OTHER

Sponsor Role collaborator

Mindong Hospital of Ningde

UNKNOWN

Sponsor Role collaborator

The Fifth Hospital of Xiamen

UNKNOWN

Sponsor Role collaborator

People's Hospital of Ningxia Hui Autonomous Region

OTHER

Sponsor Role collaborator

The First People's Hospital of Changzhou

OTHER

Sponsor Role collaborator

The Fifth hospital of Deyang

UNKNOWN

Sponsor Role collaborator

Suzhou Municipal Hospital

OTHER

Sponsor Role collaborator

Tang-Du Hospital

OTHER

Sponsor Role collaborator

Yiyang Central Hospital

UNKNOWN

Sponsor Role collaborator

First Affiliated Hospital of Xinjiang Medical University

OTHER

Sponsor Role collaborator

Peng Ding Shan Shi Zhong Yi Yi Yuan

UNKNOWN

Sponsor Role collaborator

Yueyang Central Hospital

OTHER

Sponsor Role collaborator

The First People's Hospital of Lianyungang

OTHER

Sponsor Role collaborator

Haimen District Traditional Chinese Medicine Hospital

UNKNOWN

Sponsor Role collaborator

The 910th Hospital

UNKNOWN

Sponsor Role collaborator

The Second Affiliated Hospital of Zhejiang Chinese Medical University

OTHER

Sponsor Role collaborator

Beijing Tiantan Hospital

OTHER

Sponsor Role collaborator

Affiliated Hospital of Jiangsu University

OTHER

Sponsor Role collaborator

Liaocheng People's Hospital

OTHER

Sponsor Role collaborator

Beijing Chao Yang Hospital

OTHER

Sponsor Role collaborator

Jilin City Hospital of Chemical Industry

UNKNOWN

Sponsor Role collaborator

Creen Hospital-465

UNKNOWN

Sponsor Role collaborator

Wuhan Central Hospital

OTHER

Sponsor Role collaborator

Air Force Military Medical University, China

OTHER

Sponsor Role collaborator

Shanghai Tong Ren Hospital

OTHER

Sponsor Role collaborator

Beijing Anzhen Hospital

OTHER

Sponsor Role collaborator

Emergency General Hospital

OTHER

Sponsor Role collaborator

Beijing Tongren Hospital

OTHER

Sponsor Role collaborator

Civil Aviation General Hospital

OTHER

Sponsor Role collaborator

Peking University Shougang Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Anhui Medical University

OTHER

Sponsor Role collaborator

Chinese PLA Central Hospital

UNKNOWN

Sponsor Role collaborator

Beijing Tsinghua Chang Gung Hospital

OTHER

Sponsor Role lead

Responsible Party

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Zhifeng Gao

Deputy director, Department of Anesthesiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lan Yao

Role: PRINCIPAL_INVESTIGATOR

Peking University International Hospital

Hui Q Xu

Role: PRINCIPAL_INVESTIGATOR

Wangjing Hospital, China Academy of Chinese Medical Sciences

Yan Liu

Role: PRINCIPAL_INVESTIGATOR

ZhuHai Hospital

Qi Pan

Role: PRINCIPAL_INVESTIGATOR

Beijing Hospital

Jian H Jia

Role: PRINCIPAL_INVESTIGATOR

Siyang County Hospital of Traditional Chinese Medicine

Yi K Zhu

Role: PRINCIPAL_INVESTIGATOR

Second Hospital of Shanxi Medical University

Ke F Shi

Role: PRINCIPAL_INVESTIGATOR

Henan Provincial Chest Hospital

Fang F Zhang

Role: PRINCIPAL_INVESTIGATOR

Fuzhou First Hospital

Xiu Zh Wang

Role: PRINCIPAL_INVESTIGATOR

Pinggu District Hospital of Traditional Chinese Medicine

Feng Hong

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Anhui University of Chinese Medicine

Ying J Hao

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Zhengzhou University

Yi Q Cai

Role: PRINCIPAL_INVESTIGATOR

Mindong Hospital of Ningde

Lin Shen

Role: PRINCIPAL_INVESTIGATOR

Heze Hospital of Traditional Chinese Medicine

Jin L Liang

Role: PRINCIPAL_INVESTIGATOR

The Fifth Hospital of Xiamen

Zhen Wang

Role: PRINCIPAL_INVESTIGATOR

People's Hospital of Ningxia Hui Autonomous Region

Hong W Ye

Role: PRINCIPAL_INVESTIGATOR

The First People's Hospital of Changzhou

Qin Wang

Role: PRINCIPAL_INVESTIGATOR

The Fifth hospital of Deyang

Jian P Qiu

Role: PRINCIPAL_INVESTIGATOR

Suzhou Municipal Hospital

Bo Liao

Role: PRINCIPAL_INVESTIGATOR

Tang-Du Hospital

Xin J Liu

Role: PRINCIPAL_INVESTIGATOR

Yiyang Central Hospital

Guo Sh Gu

Role: PRINCIPAL_INVESTIGATOR

Anhui No.2 Provincial People's Hospital

Li Quan

Role: PRINCIPAL_INVESTIGATOR

First Affiliated Hospital of Xinjiang Medical University

Li R Ma

Role: PRINCIPAL_INVESTIGATOR

Peng Ding Shan Shi Zhong Yi Yi Yuan

Zhi B Zhao

Role: PRINCIPAL_INVESTIGATOR

The First People's Hospital of Lianyungang

Xin Lu

Role: PRINCIPAL_INVESTIGATOR

Haimen District Traditional Chinese Medicine Hospital

Feng Zhou

Role: PRINCIPAL_INVESTIGATOR

Yueyang Central Hospital

Xiao D Yin

Role: PRINCIPAL_INVESTIGATOR

Zhe Cheng TCM Hospital

Li T Zhang

Role: PRINCIPAL_INVESTIGATOR

The 910th Hospital

Yu Zh He

Role: PRINCIPAL_INVESTIGATOR

The Second Affiliated Hospital of Zhejiang Chinese Medical University

Xiao M Zhang

Role: PRINCIPAL_INVESTIGATOR

The first People's Hospital of Zhengzhou

Yu H Jiang

Role: PRINCIPAL_INVESTIGATOR

Beijing Tiantan Hospital

Peng Jiang

Role: PRINCIPAL_INVESTIGATOR

Affiliated Hospital of Jiangsu University

Xiao Y Li

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Zhengzhou University

Zhi H Liu

Role: PRINCIPAL_INVESTIGATOR

Liaocheng People's Hospital Zhiheng Liu

Jin C Yang

Role: PRINCIPAL_INVESTIGATOR

Beijing Chao Yang Hospital

Xue L Zhu

Role: PRINCIPAL_INVESTIGATOR

The People's Hospital of Nanchuan, Chongqing

Wen T Si

Role: PRINCIPAL_INVESTIGATOR

Zhengzhou Orthopaedic Hospital

Lei Ning

Role: PRINCIPAL_INVESTIGATOR

Jilin City Hospital of Chemical Industry

Li H Su

Role: PRINCIPAL_INVESTIGATOR

Creen Hospital-465

Zhong J Wang

Role: PRINCIPAL_INVESTIGATOR

Wuhan Central Hospital

Li P Ma

Role: PRINCIPAL_INVESTIGATOR

Beijing Anzhen Hospital

Yu H Xu

Role: PRINCIPAL_INVESTIGATOR

Air Force Military Medical University, China

Jiang M Yu

Role: PRINCIPAL_INVESTIGATOR

Tong Ren hospital Shanghai Jiao Tong university school of medicine

Qing H Cheng

Role: PRINCIPAL_INVESTIGATOR

Emergency General Hospital

Hui J Wang

Role: PRINCIPAL_INVESTIGATOR

Beijing Tongren Hospital, CMU

Jun Wu

Role: PRINCIPAL_INVESTIGATOR

Heilongjiang provincial hospital

Jun T Duan

Role: PRINCIPAL_INVESTIGATOR

Civil Aviation General Hospital

Zheng G Guo

Role: PRINCIPAL_INVESTIGATOR

Peking University Shougang Hospital

Xin Kuang

Role: PRINCIPAL_INVESTIGATOR

The People's Hospital of Longhua, Shenzhen

Chang J Yu

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Anhui Medical University

Feng Liang

Role: PRINCIPAL_INVESTIGATOR

Chinese PLA Central Hospital

Locations

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Zhifeng Gao

Beijing, Beijing Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Zhi F Gao, M.D.

Role: CONTACT

+86 15801249466

Facility Contacts

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Zhifeng Gao, MD

Role: primary

18756235568

References

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Duan Y, Ding L, Gao Z, Wang Y, Cao H, Zhang H, Yao L. Assessing the effectiveness of continuous glucose monitoring compared with conventional monitoring in enhancing surgical outcomes for patients with diabetes: protocol for a multicentre, parallel-arm, randomised, pragmatic trial in China. BMJ Open. 2025 Feb 18;15(2):e090664. doi: 10.1136/bmjopen-2024-090664.

Reference Type DERIVED
PMID: 39965943 (View on PubMed)

Other Identifiers

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U1111-1305-0484

Identifier Type: -

Identifier Source: org_study_id

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