Summary: In the two-center DIATEC randomized trial, diabetes-team insulin titration guided by inpatient continuous glucose monitoring (CGM) increased median time in range from 62.7% to 77.6% compared with point-of-care glucose testing in adults with type 2 diabetes outside the intensive care unit.
PICO Summary
| Element | Detail |
|---|---|
| Population | 166 adults with type 2 diabetes admitted to non-intensive care units at two centers. |
| Intervention | Diabetes-team oversight with insulin titration algorithms guided by CGM. |
| Comparator | Diabetes-team oversight with insulin titration algorithms guided by point-of-care glucose testing. |
| Outcomes | Median time in range (3.9-10.0 mmol/L) was 77.6% versus 62.7% (P<0.001). CGM also reduced time above range, time below range and prolonged hypoglycemia (IRR 0.13; 95% CI 0.04-0.46; P=0.001), as well as insulin use and a composite of complications. |
| Study design | Two-center randomized controlled trial during hospitalization. |
DIATEC: Inpatient CGM
RCT - 166 non-ICU patients
Inpatient CGM-guided insulin titration increased time in range and reduced several glycemic safety signals in a small two-center randomized trial.
Expert Commentary
This trial is clinically useful because it tests a practical inpatient workflow rather than a sensor in isolation. In non-ICU adults with type 2 diabetes, diabetes-team oversight plus CGM-guided insulin titration increased median time in range from 62.7% to 77.6% during hospitalization. CGM also reduced time above range, time below range, prolonged hypoglycemia, glycemic variability, daily insulin dose, and a composite of complications. The direction of effect is coherent, although the study was conducted at two centers and follow-up ended at discharge.
Can I use this with my patients? For hospitals that already have diabetes-team support and can respond to CGM data, this supports considering CGM-guided inpatient insulin titration. It does not establish that every inpatient needs CGM, nor does it show post-discharge benefit. The staffing model, algorithm, sensor workflow, and local nursing experience are important parts of the intervention. The randomized sample was modest, and hospital complications were a composite rather than a mortality endpoint. Before implementation, teams should define who reviews readings, how confirmatory glucose testing is handled, and how hypoglycemia is escalated. Medication changes, nutrition, renal function, steroid exposure and acute illness still require clinical assessment. The study supports a structured inpatient pathway, not unsupervised CGM use or a replacement for bedside judgment.
References
Olsen MT, Klarskov CK, Jensen SH, Rasmussen LM, Lindegaard B, Andersen JA, et al. In-Hospital Diabetes Management by a Diabetes Team and Insulin Titration Algorithms Based on Continuous Glucose Monitoring or Point-of-Care Glucose Testing in Patients With Type 2 Diabetes (DIATEC): A Randomized Controlled Trial. Diabetes Care. 2025. doi:10.2337/dc24-2222. PMID: 39887698.