Remote Glucose Monitoring in Hospital Settings

Diabetes Mellitus, Type 2 Clinical Trial

— REMOTE-CGM  

Official title:

A Pilot Randomised Study to Assess Use of Real-time Continuous Glucose Monitoring in Comparison to Conventional Capillary Blood Glucose Monitoring During COVID-19 Pandemic in Hospitalised Patients With Diabetes Mellitus.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04797208
• Other study ID #: B01121
• Status: Recruiting
• Phase: N/A
• Start date: January 9, 2023
• Est. completion date: August 31, 2023

Study information

• Verified date: February 2023
• Source: Manchester University NHS Foundation Trust
• Contact: Mohammed Nazir
• Phone: 0161 901 3560
• Email: Mohammed.Nazir[@]cmft.nhs.uk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Use of real-time continuous glucose monitoring (RT-CGM) systems in inpatient settings especially during the COVID-19 pandemic, may allow hospital staff to remotely monitor glucose while reducing viral exposure and preserving use of PPE. RT-CGM may be of benefit to inpatients with unstable glycaemia and at risk of severe hypoglycaemia, as it can automatically alert the treating clinical team of hypo and hyperglycaemia. This is of clinical relevance as up to 45% of inpatients with diabetes were found to have asymptomatic hypoglycaemia events in hospital, especially overnight. It may therefore provide a safer method of monitoring glycaemia in hospital compared to conventional bedside capillary glucose testing, by minimising the likelihood of hyper- and hypoglycaemic events and their known associated worse outcomes.

The aim of this pilot study is to to demonstrate that use of Dexcom G6 RT-CGM may provide a safer and effective method of monitoring glycemia in hospital. Data from this pilot study will be used to design and implement a larger multi-centre pivotal trial.

Description:

Hyperglycaemia in hospitalized patients is becoming a common clinical problem due to the increasing prevalence of diabetes mellitus. Hyperglycaemia in this cohort can also occur in patients with previously undiagnosed diabetes, or during acute illness in those with previously normal glucose tolerance. A growing body of evidence currently suggest that the degree of hyperglycaemia upon admission and the duration of hyperglycaemia during their illness are associated with adverse outcomes. In-patient hyperglycaemia is now widely recognised as a poor prognostic marker in terms of morbidity and mortality, increased length of stay and cost to the healthcare system. Analysis of data from nine randomised controlled trials and ten observational studies reported that treatment of hyperglycaemia in non-critically ill patients was associated with reduction in the risk of infection (relative risk, 0.41;95% confidence interval, 0.21-0.77).

The current management of inpatient hyperglycaemia in non-critical care is still far from ideal, and vary widely between different centres . The discordance between clinical evidence and practice is due to a number of factors which could potentially undermine patient care and safety. Of these, hypoglycaemia remains one the biggest barriers to managing in-patient hyperglycaemia. Hypoglycaemia is associated with increased length of stay (up to 2.3 times higher) and inpatient mortality. A recent meta-analyses reported that intensive glycaemic control on non-critical care patients is associated with a trend of increased risk of hypoglycaemia. Optimal glycaemic inpatient glucose targets still remain an intensely debated subject. Consensus from the American Association of Clinical Endocrinologists (AACE) and American Diabetes Association (ADA) recommended specified targets for hospitalised patients, of fasting or pre-meal blood glucose <7.8mmol/l and random blood glucose <10mmol/l.

Outpatient use of real-time continuous glucose monitoring (RT-CGM) is gradually increasing. Its implementation in the outpatient setting has been supported by robust scientific and clinical studies, showing benefits in glycaemic control, minimising hypoglycaemia and improving patient experience. Extending use of RT-CGM systems to inpatient settings especially during the COVID-19 pandemic may allow hospital staff to remotely monitor glucose while reducing viral exposure through frequent patient contact and preserving personal protective equipment (PPE). RT-CGM may be of benefit to inpatients with unstable glycemia (i.e. COVID-19 patients receiving dexamethasone therapy) and at risk of severe hypoglycemia, as it can automatically alert the treating clinical team of hypo- and hyperglycemia. Use of RT-CGM in hospital could therefore potentially benefits patients by improving their glycaemic control, and healthcare professionals working in busy general ward settings by providing remote real-time glucose monitoring from the patient every 10 minutes.

The main objective of this study is to assess the efficacy of RT-CGM in maintaining glucose levels within the target range (5.6 to 10.0 mmol/l) compared to conventional glucose monitoring in hospitalised insulin-treated T2D. Other objectives include evaluating safety of RT-CGM in terms of reducing the incidence of hypoglycaemia, severe hyperglycaemia, and collecting feedback of participants and healthcare professionals using RT-CGM in the general ward settings.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 30
• Est. completion date: August 31, 2023
• Est. primary completion date: August 31, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Aged 18 years or older

2. Diagnosed with Type 2 diabetes

3. Currently receiving treatment with subcutaneous insulin alone, or in combination with oral glucose-lowering medication(s)

4. At least one CBG level > 10mmol/l

5. Have the ability to consent in English

Exclusion Criteria:

1. Autoimmune type 1 diabetes

2. Known or suspected allergy against insulin

3. Current or planned pregnancy or breast feeding

4. Current in-patient in intensive care unit

5. Planned surgery during study period

6. Any physical or psychological disease or medication(s) likely to interfere with the conduct of the study and interpretation of the study results, as judged by the study clinician.

7. Likely discharge earlier than 72 hours

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Hyperglycemia
• Hyperglycemia Stress
• Hypoglycemia

Intervention

Device:
• Real-Time CGM
Participants will be wearing a real-time continuous glucose sensor which will enable their glucose levels to be remotely monitored. High and Low glucose alerts will also be available.
• Capillary blood glucose testing with masked CGM
Participants will have their glucose monitored in hospital in the conventional manner using the NovaStat® glucometer or similar CE-marked glucose meter) and insulin dose adjusted by the treating clinical team as per usual hospital guidelines. A masked subcutaneous CGM will be inserted for data collection only.

Locations

Country	Name	City	State
United Kingdom	Manchester Royal Infirmary	Manchester	Greater Manchester

Sponsors (2)

Lead Sponsor	Collaborator
Manchester University NHS Foundation Trust	Manchester Academic Health Science Centre

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Severe hypoglycaemia	Frequency of Level 3 (severe hypoglycaemia) events and number of hypoglycaemia treatments required	Up to 10 days
Other	Significant hyperglycaemia	Frequency of significant hyperglycaemia (>20mmol/l) events	Up to 10 days
Other	Usability	Feedback and experience of using CGM from participants and healthcare professionals	Up to 10 days
Primary	Time in range	% of time spent in target glucose sensor range (5.6-10.0mmol/l)	Up to 10 days
Secondary	Time above range	% of time spent above target glucose sensor range (>10.0mmol/l)	Up to 10 days
Secondary	Time below range	% of time spent below target glucose sensor range (<5.6mmol/l)	Up to 10 days
Secondary	Average sensor glucose	Mean glucose values as recorded by CGM	Up to 10 days
Secondary	Glucose variability	Coefficient of variation of glucose levels, as recorded by CGM	Up to 10 days
Secondary	Level 1 hypoglycaemia	% of time with sensor glucose values between 3.0 - 3.9 mmol/l	Up to 10 days
Secondary	Level 2 hypoglycaemia	% of time with sensor glucose values <3.0 mmol/l	Up to 10 days