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Randomized Controlled Trial
. 2025 Jan 1;48(1):118-124.
doi: 10.2337/dc24-1779.

Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study

Irl B Hirsch  1 , Boris Draznin  2 , John B Buse  3 , Dan Raghinaru  4 , Charles Spanbauer  4 , Guillermo E Umpierrez  5 , Jagdeesh Ullal  6 , Morgan S Jones  3 , Cecilia C Low Wang  2 , Elias K Spanakis  7   8 , Jing H Chao  1 , Judy Sibayan  4 , Craig Kollman  4 , Zohyra E Zabala  5 , Bobak Moazzami  5 , Shari L Reynolds  6 , Wanda Ferrara  6 , Karla Fulghum  3 , Alex Kass  3 , Chase Armstrong  3 , Faryal Gilani  3 , Stacey Seggelke  2 , Jade Churchill  8 , Joseph O Monye  7 , Monica Y Choe  8 , William Scott  8 , Jesica D Baran  1 , Rajlaxmi Bais  1 , Dori Khakpour  1 , Francisco J Pasquel  5 , Georgia M Davis  5 , Priyathama Vellanki  5 , Erin E Kershaw  6 , Nikola Gligorijevic  6 , April Goley  3 , Avni Garg  3 , Bonnie Alexander  3 , Brooke C Matson  3 , Jamie Diner  3 , Klara R Klein  3 , Whitney B Adair  2 , Palak Choksi  2 , Michelle Huang  2 , Jennifer Vinh  2 , Lakshmi G Singh  8 , Roy W Beck  4 ; TIGHT RCT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study

Irl B Hirsch et al. Diabetes Care. .

Abstract

Objective: To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes.

Research design and methods: At six academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with glucose target 140-180 mg/dL (standard group) or intensive therapy with glucose target 90-130 mg/dL guided by CGM (intensive group). The primary outcome was mean glucose measured with CGM (blinded in standard group), and the key secondary outcome was CGM glucose <54 mg/dL.

Results: For the 110 participants included in the primary analysis, mean ± SD age was 61 ± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL for the intensive group (n = 60) vs. 175 mg/dL for the standard group (n = 50; risk-adjusted difference -7 mg/dL, 95% CI -19 to 5; P = 0.25). Only 7% of the intensive group achieved the mean glucose target range of 90-130 mg/dL. CGM readings <54 mg/dL were infrequent (0.2% for intensive and 0.4% for standard; adjusted treatment group difference -0.1%, 95% CI -0.6 to 0.3). One severe hypoglycemia event occurred in the standard group.

Conclusions: The study's glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non-intensive care unit hospital setting. A glucose target of 90-130 mg/dL may not be realistic in the current environment of insulin management in the hospital.

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Conflict of interest statement

Duality of Interest. This study was supported by funding from Dexcom to the JAEB Center for Health Research, which then provided funding to the clinical sites. I.B.H. reports research support from Dexcom, Tandem Diabetes Care, and MannKind and consulting fees from Abbott Diabetes Care, Roche, embecta, and Vertex Pharmaceuticals. J.B.B. reports research support from Bayer, Boehringer Ingelheim, Carmot Therapeutics, Corcept Therapeutics, Dexcom, Eli Lilly, Insulet, MannKind, Novo Nordisk, and vTv Therapeutics; consulting fees from Alkahest, Altimmune, Anji, Aqua Medical, AstraZeneca, Boehringer Ingelheim, CeQur, Corcept Therapeutics, Eli Lilly, embecta, GentiBio, Glyscend, Insulet, Mediflix, Medscape, Medtronic, Mellitus Health, Metsera, Moderna, Novo Nordisk, Pendulum Therapeutics, Praetego, ReachMD, Stability Health, Tandem Diabetes Care, Terns Pharmaceuticals, and Vertex Pharmaceuticals; and stock options from Glyscend, Mellitus Health, Pendulum Therapeutics, Praetego, and Stability Health. G.E.U. has received research support (to Emory University) from Abbott, Dexcom, and Bayer and has served as a member of advisory boards for Dexcom and GlyCare. J.U. reports research grants from the Cystic Fibrosis Foundation and the Jaeb Center for Health Research, payment or honoraria for lectures from ADA, and leadership or fiduciary roll for the Greater Pittsburgh Diabetes Club. C.C.L.W. has received research support from Dexcom and Virta Health. E.K.S. has received research support from Dexcom and Tandem Diabetes Care for the conduct of clinical trials (at the Baltimore Veterans Affairs Medical Center and University of Maryland). This work was supported in part by the U.S. Department of Veterans Affairs Merit award (1I01CX001825) and Cooperative Studies Program (CSP-2002). F.J.P. has received research support through his institution from Dexcom, Tandem Diabetes Care, Insulet, Novo Nordisk, and Ideal Medical Technologies and personal consulting fees from Dexcom and has provided consulting services for Insulet (services paid to his institution). E.E.K. has received investigator-initiated research support through her institution from Pfizer and Vertex Pharmaceuticals and has served as an investigator in industry-sponsored clinical trials for Eli Lilly and Regeneron Pharmaceuticals. B.C.M. reports grants from the Endocrine Fellows' Foundation and support for attending meetings and/or travel from ADA and the Endocrine Society. K.R.K. has received consulting fees from Novo Nordisk. Additionally, K.R.K. has received research-related contracts (paid to the institution) from Bayer, Boehringer Ingelheim, Carmot Therapeutics, Diasome, Eli Lilly, Novo Nordisk, Rhythm Pharmaceuticals, and vTv Therapeutics. R.W.B. reports that his institution has received funding on his behalf as follows: grant funding and consulting fees from Insulet, Tandem Diabetes Care, and Beta Bionics; grant funding and study supplies from Dexcom, grant funding from Bigfoot Biomedical, embecta, Sequel Med Tech, and MannKind; and consulting fees and study supplies from Novo Nordisk; consulting fees from Vertex Pharmaceuticals, Hagar, Ypsomed, Sanofi, and Zucara Therapeutics and study supplies from Medtronic, Ascencia, Roche, and Eli Lilly. No other potential conflicts of interest relevant to this article were reported.

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