Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial

Moon, Sun-Joon; Kim, Min-Su; Kim, Yun Tae; Lee, Ha-Eun; Lee, Young-Woo; Lee, Su-Ji; Chung, Euy-Suk; Park, Cheol-Young

doi:10.1186/s12933-025-02747-z

Cardiovascular Diabetology

Table 2 CGM and surgical outcomes of total participants

From: Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial

	Baseline		Study period
	POC	CGM	POC	CGM	Adjusted difference or odds ratio (95% CI)	Adjusted p value	FDR adjusted p value
CGM outcomes
TIR 100–180 mg/dL, %	67.9 ± 25.3	64.0 ± 20.3	71.6 ± 17.8	74.7 ± 12.0	3.5 (– 3.4 to 10.3)	0.313	0.376
TIR 70–180 mg/dL, %	72.4 ± 26.3	68.8 ± 23.6	75.8 ± 18.9	83.8 ± 10.6	8.8 (1.9 to 15.6)	0.013	0.026
TITR 100–140 mg/dL, %	32.4 ± 24.0	25.3 ± 20.8	36.3 ± 19.0	46.3 ± 15.4	11.4 (3.5 to 19.4)	0.006	0.018
TITR 70–140 mg/dL, %	37.0 ± 28.3	30.0 ± 26.8	40.5 ± 22.5	55.3 ± 15.3	16.8 (7.5 to 26.0)	< 0.001	0.003
TAR > 180 mg/dL, %	27.0 ± 26.7	30.9 ± 23.6	24.2 ± 18.9	16.0 ± 10.5	– 8.9 (– 15.8 to– 2.1)	0.012	0.026
TAR > 250 mg/dL, %	7.6 ± 20.1	3.9 ± 8.0	3.8 ± 7.1	1.8 ± 2.7	– 2.2 (– 4.6 to 0.2)	0.067	0.101
TBR < 70 mg/dL, %	0.58 ± 2.25	0.38 ± 1.55	0.03 ± 0.11	0.18 ± 0.39	0.15 (– 0.02 to 0.32)	0.082	0.109
TBR < 54 mg/dL, %	0.29 ± 1.39	0.22 ± 0.78	0.01 ± 0.04	0.00 ± 0.02	– 0.01 (– 0.03 to 0.01)	0.385	0.420
Mean glucose, mg/dL	163.4 ± 43.0	163.3 ± 27.6	157.3 ± 23.3	142.5 ± 13.0	– 16.3 (– 24.4 to– 8.1)	< 0.001	0.001
SD, mg/dL	30.8 ± 13.1	32.9 ± 11.4	35.3 ± 13.8	36.2 ± 10.6	0.8 (– 4.0 to 5.6)	0.733	0.733
CV, %	19.3 ± 7.8	20.3 ± 6.3	22.0 ± 6.2	25.0 ± 5.9	3.3 (0.6 to 5.9)	0.017	0.029
Surgical outcomes
Atrial fibrillation, n (%)	7 (28.0)	11 (40.7)	10 (55.6)	3 (18.8)	0.04 (0.00 to 0.46)	0.010	0.050
Pneumonia, n (%)	0 (0.0)	0 (0.0)	2 (8.0)	2 (7.4)	0.16 (0.01 to 5.23)	0.306	0.765
Wound infection, n (%)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	NA^†	NA	NA
CRRT, n (%)	1 (4.0)	1 (3.7)	0 (0.0)	0 (0.0)	NA^†	NA	NA
Symptomatic CVA, n (%)	2 (8.0)	2 (7.4)	0 (0.0)	0 (0.0)	NA^†	NA	NA
CRP change, mg/dL*	3.6 ± 15.4	2.2 ± 5.3	15.2 ± 18.4	14.9 ± 7.1	– 1.5 (– 9.5 to 6.5)	0.704	0.880
Length of hospital stay, days	NA	NA	17.6 ± 7.9	18.9 ± 8.3	– 0.2 (– 4.6 to 4.3)	0.937	0.937
Length of ICU stay, days	NA	NA	3.9 ± 5.7	5.1 ± 5.8	– 0.6 (– 3.0 to 1.8)	0.618	0.880
Mortality within 30 days, n (%)	NA	NA	0 (0.0)	0 (0.0)	NA	NA	NA

Data are presented as mean (standard deviation) or n (%). Diabetes and prediabetes status, baseline A1c, baseline TIR 70–180 mg/dL, postoperative day of multiple daily injection transition were adjusted were adjusted for in the analyses. When analyzing surgical outcomes, participants who had already experienced the outcomes at baseline were excluded
^* CRP values are reported as follows: for baseline, the actual baseline CRP value is given; for the study period, the change from the baseline value is reported
^† The variables are presented as adjusted odds ratio otherwise are presented as adjusted difference
Abbreviations: CGM, continuous glucose monitoring; CI confidence interval; CRP, C-reactive protein; CRRT, continuous renal replacement therapy; CV, coefficient of variation; CVA, cerebrovascular accident; FDR, false discovery rate; ICU, intensive care unit; NA, not applicable; POC, point-of-care; SD, standard deviation; TAR, time above range; TBR, time below range; TIR, time in range; TITR, time in tight range

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