Transition from CSII to Second-Generation Basal Insulin Analogues in Hospitalized T2DM Patients: A CGM-Based Study

Background The optimal approach for transitioning hospitalized patients with type 2 diabetes from continuous subcutaneous insulin infusion (CSII) to second-generation basal insulin analogues remains unclear. Methods This retrospective analysis included 135 patients transitioning from CSII to insulin degludec (IDeg, n = 77) or insulin glargine U300 (IGlar U300, n = 58), assessed by continuous glucose monitoring (CGM). Results Glycemic control improved significantly post-transition in both groups (time in range: IDeg 73.0%, IGlar U300 73.6%; both P  < 0.001 versus CSII). Post-transition profiles were comparable across key metrics: overall control (time in range, P  = 0.912), glycemic variability (coefficient of variation: 29.8% vs. 29.2%, P  = 0.629), and hypoglycemia risk (time below range: 0.8% vs. 0.5%, P  = 0.915). IDeg demonstrated lower fasting glucose variability (coefficient of variation of fasting glucose: 23.8% vs. 28.3%, P  = 0.024) and a later nocturnal glucose nadir. Lower body mass index correlated strongly with poorer post-transition outcomes, coinciding with more frequent use of multiple daily injection regimens in these patients (36.1% vs. 6.3%, P  < 0.001). Lower serum albumin consistently associated with greater glycemic variability. Conclusions Transition from CSII to either IDeg or IGlar U300 is effective and safe. IDeg may provide greater fasting glucose stability. Transition success requires personalized discharge planning based on BMI and albumin levels.