Starting CGM Use at Hospital Discharge Did Not Reduce Readmission Risk in Type 2 Diabetes Patients

Carmen Cartwright, MD

While multiple studies have previously outlined the impact of continuous glucose monitors (CGM) on glucose control in patients with diabetes, a new study has returned results suggesting use of CGM did not reduce emergency department visits or hospital readmissions among patients with uncontrolled type 2 diabetes.

A nonblinded, randomized study presented at the American Academy of Clinical Endocrinology’s 30th Annual Meeting (AACE 2021), results indicate use of CGM for 2 weeks upon hospital discharge did not result in a significant difference in HbA1c control or rates of hospitalization compared against standard care.

“Contrary to our expectation and hypothesis, continuous glucose monitor use for two weeks immediately post-hospitalization did not lead to reductions in ED visits or hospital readmissions. Our study suggests that further exploration regarding the use of continuous glucose monitors for reduction of hospital readmissions, specifically in type 2 diabetics, is needed,” concluded investigators.

Presented by Carmen Cartwright, MD, an endocrinology fellow at Einstein Medical Center, the current study was conducted by colleagues from the Einstein Healthcare Network’s Department of Endocrinology and sought to explore whether use of CGM immediately after hospitalization could improve glucose control and reduce emergency department visits as well as hospital readmissions. To do so, investigators designed the current study as a prospective, randomized single-center trial randomizing patients to CGM or standard medical management between October 2018 and September 2020.

For inclusion in the trial, patients needed to have type 2 diabetes, be at least 18 years of age or older, and have an HBA1c level equal to or greater than 9%. Additionally, patients were required to have full demographic data and information related to HbA1c levels, sensor and/or glucose logs 2 weeks after discharge, and emergency department visits and hospitalizations up to 6 months following discharge.

In total, 58 patients were enrolled in the study. This group include 28 randomly assigned to the Freestyle Libre Pro CGM for 2 weeks post discharge and the remaining 30 receiving standard medical management. Of note, the mean starting HbA1c was 11.35% in the CGM group and 11.12% in the control group.

Upon analysis, HbA1c improvements in the control and intervention group were not statistically or clinically significant different between the study groups. At 3 months, the mean HbA1c was 8.4% for the control group and 8.3% for the CGM group. At 6 months, these levels were 9.1% and 8.9% for the control and CGM groups, respectively.

When assessing the impact on emergency department visits and hospital readmissions at 6 months, investigators noted a marked, but not statistically significant difference between the study arms. Specifically, 57.1% and 35.7% of the intervention and control groups, respectively, had at least 1 emergency department visits within the 6 months following discharge (95% CI, -0.04 to 46.9; P=.18). Additionally, 42% and 32.1% of the intervention and control group, respectively, had at least 1 hospital admission within the 6 months following discharge (95% CI, -0.14 to 35.9; P =.58).

Subjects whether assigned to continuous glucose monitoring or self-monitoring of blood glucose levels were able to achieve similar hemoglobin A1c reductions.

"We propose this is due to improved education and patient self-awareness for disease monitoring during sentinel hospital visit,” noted investigators.

This study, “Reducing ED Visits and Hospital Readmissions and Improving Glucose Control of Patients with Uncontrolled Type 2 Diabetes by Use of Continuous Glucose Monitoring Sensors Placed at Hospital Discharge,” was presented at AACE 2021.