Continuous Glucose Monitoring–Guided Insulin Optimization in Patients Receiving Nocturnal Parenteral Nutrition

OBJECTIVE To evaluate whether a continuous glucose monitoring (CGM) system (CGMS)–guided insulin optimization can improve glucose control and nutritional status in insulin-treated patients receiving long-term nocturnal parenteral nutrition (PN). RESEARCH DESIGN AND METHODS In this prospective single-center study, 12 insulin-treated adults with chronic intestinal failure undergoing nocturnal cyclic PN underwent 30-day CGM assessment before and after a diabetologist-led optimization of insulin therapy. RESULTS Glucose profiles improved after the intervention: less time >250 mg/dL (27% to 17%; −139 ± 113 min/day; P = 0.02), more time in range (44% to 59%; +206 ± 118 min/day; P = 0.002), and without more hypoglycemia. HbA1c decreased by −0.7% (−8 mmol/mol; P = 0.04), and glycosuria resolved in all affected patients (P = 0.03). Body weight increased by +5 kg (interquartile range 4–7.75; P = 0.006), as did serum albumin (+8 g/L; P = 0.006). Malnutrition resolved among 8 of 11 participants (P < 0.05). CONCLUSIONS CGMS-guided insulin optimization was associated with improvements in glucose control and nutritional status.