Acceptance and Effect of Continuous Glucose Monitoring on Discharge From Hospital in Patients With Type 2 Diabetes: Open-label, Prospective, Controlled Study

Abstract

Background Continuous glucose monitors (CGM) can provide detailed information on glucose excursions. There is little information on safe transitioning from hospital back to the community for patients who have had diabetes therapies adjusted in hospital and it is unclear whether newer technologies may facilitate this process. Objective Our aim was to determine whether offering CGM on discharge would be acceptable and if CGM initiated on hospital discharge in people with type 2 diabetes (T2DM) would reduce hospital re-presentations at 1 month. Methods This was an open-label study. Adult inpatients with T2DM, who were to be discharged home and required postdischarge glycemic stabilization, were offered usual care consisting of clinic review at 2 weeks and at 3 months. In addition to usual care, participants in the intervention arm were provided with a Libre flash glucose monitoring system (Abbott Australia). An initial run-in phase for the first 20 participants was planned, where all consenting participants were enrolled in an active arm. Subsequently, all participants were to be randomized to the active arm or usual care control group. Results Of 237 patients screened during their hospital admission, 34 had comorbidities affecting cognition that prevented informed consent and affected their ability to learn to use the CGM device. In addition, 21 were not able to be approached as the material was only in English. Of 101 potential participants who fulfilled eligibility criteria, 19 provided consent and were enrolled. Of the 82 patients who declined to participate, 31 advised that the learning of a new task toward discharge was overwhelming or too stressful and 26 were not interested, with no other details. Due to poor recruitment, the study was terminated without entering the randomization phase to determine whether CGM could reduce readmission rate. Conclusions These results suggest successful and equitable implementation of telemedicine programs requires that any human factors such as language, cognition, and possible disengagement be addressed. Recovery from acute illness may not be the ideal time for introduction of newer technologies or may require more novel implementation frameworks.

Use of Continuous Glucose Monitors Upon Hospital Discharge of People With Diabetes: Promise, Barriers, and Opportunity

“…We further reviewed the 19 articles cited by Depczynski and Poynten and the one article listed in PubMed as citing Depczynski and Poynten. 18 We found none of these articles to be relevant. In addition, we found three results on Google Scholar that cited Depczynski and Poynten.…”

“…The one relevant original article was an open-label study performed by Depczynski and Poynten, in which 2 of 19 enrolled people with diabetes, all of whom received a CGM upon hospital discharge, were readmitted within 30 days. 18 While their 30-day readmission rate of 10.5% is lower than the national average of 14%, 8 the study suffers from poor recruitment (19 enrolled out of 101 eligible participants) and a small sample size. 18 The enrolled participants had a median hemoglobin A1c of 10.9% at enrollment and 8.0% three months later.…”

“…18 While their 30-day readmission rate of 10.5% is lower than the national average of 14%, 8 the study suffers from poor recruitment (19 enrolled out of 101 eligible participants) and a small sample size. 18 The enrolled participants had a median hemoglobin A1c of 10.9% at enrollment and 8.0% three months later. The article did not present the clinical characteristics of the 82 nonenrolled participants.…”

“…In addition, we found three results on Google Scholar that cited Depczynski and Poynten. 18 Of these three results, two were excluded for not being listed in PubMed, and the remaining one was a duplicate found via PubMed.…”

“…Figure 1 is a PRISMA diagram of the literature search that was performed. Based on the results of Depczynski’s study, 18 it is unclear how to extrapolate this data to other hospitals and health care systems about whether CGMs can be used to improve transition of care from the hospital to the individual’s home.…”