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

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2023 Oct 3

PMID 37784246

Authors

Tiffany Tian

Rachel E Aaron

Jane Jeffrie Seley

Rebecca Longo

Irina Nayberg

Guillermo E Umpierrez

Carol J Levy

David C Klonoff

Affiliations

Soon will be listed here.

Abstract

Continuous glucose monitors (CGMs) have increasingly been used in ambulatory and inpatient or hospital settings to improve glycemic outcomes for people with diabetes. Given their capacity to aid individuals in avoiding hypo- and hyperglycemia, they may also be useful when transitioning from hospital to home by reducing rates of hospital readmissions and emergency department visits. Several types of barriers presently exist that make the deployment of CGMs at the time of hospital discharge problematic, including (1) regulatory, (2) behavioral, (3) logistical, (4) technical, (5) staffing, and (6) systemic issues. In this commentary, we review the literature, discuss these barriers, and propose possible solutions to facilitate the use of CGMs in people with diabetes at the time of hospital discharge.

Citing Articles

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.

Umpierrez G, Davis G, ElSayed N, Fadini G, Galindo R, Hirsch I Diabetes Care. 2024; 47(8):1257-1275.

PMID: 39052901 PMC: 11272983. DOI: 10.2337/dci24-0032.

Hyperglycaemic crises in adults with diabetes: a consensus report.

Umpierrez G, Davis G, ElSayed N, Fadini G, Galindo R, Hirsch I Diabetologia. 2024; 67(8):1455-1479.

PMID: 38907161 PMC: 11343900. DOI: 10.1007/s00125-024-06183-8.

References

Depczynski B, Poynten A . Acceptance and Effect of Continuous Glucose Monitoring on Discharge From Hospital in Patients With Type 2 Diabetes: Open-label, Prospective, Controlled Study. JMIR Diabetes. 2022; 7(2):e35163. PMC: 9127644. DOI: 10.2196/35163. View

Chico A, Vidal-Rios P, Subira M, Novials A . The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control. Diabetes Care. 2003; 26(4):1153-7. DOI: 10.2337/diacare.26.4.1153. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Michaud T, Hill J, Estabrooks P, Su D . Cost analysis of a remote patient monitoring programme for post-discharge patients with type 2 diabetes. J Telemed Telecare. 2021; 29(6):417-425. DOI: 10.1177/1357633X20985393. View

Galindo R, Aleppo G, Klonoff D, Spanakis E, Agarwal S, Vellanki P . Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic. J Diabetes Sci Technol. 2020; 14(4):822-832. PMC: 7673156. DOI: 10.1177/1932296820932903. View

Rubin D, Maliakkal N, Zhao H, Miller E . Hospital Readmission Risk and Risk Factors of People with a Primary or Secondary Discharge Diagnosis of Diabetes. J Clin Med. 2023; 12(4). PMC: 9961750. DOI: 10.3390/jcm12041274. View

Roussel R, Riveline J, Vicaut E, de Pouvourville G, Detournay B, Emery C . Important Drop in Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study. Diabetes Care. 2021; 44(6):1368-1376. PMC: 8247513. DOI: 10.2337/dc20-1690. View

Yeung A, Huang J, Klonoff D, Seigel R, Goldman J, Shah S . iCoDE June 22, 2022 Steering Committee Meeting Summary Report. J Diabetes Sci Technol. 2022; 16(6):1575-1576. PMC: 9631518. DOI: 10.1177/19322968221119146. View

Shohat N, Goswami K, Breckenridge L, Held M, Malkani A, Shah R . Fructosamine is a valuable marker for glycemic control and predicting adverse outcomes following total hip arthroplasty: a prospective multi-institutional investigation. Sci Rep. 2021; 11(1):2227. PMC: 7838391. DOI: 10.1038/s41598-021-81803-6. View

10.

Ducat L, Philipson L, Anderson B . The mental health comorbidities of diabetes. JAMA. 2014; 312(7):691-2. PMC: 4439400. DOI: 10.1001/jama.2014.8040. View

11.

Sopfe J, Vigers T, Pyle L, Giller R, Forlenza G . Safety and Accuracy of Factory-Calibrated Continuous Glucose Monitoring in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation. Diabetes Technol Ther. 2020; 22(10):727-733. PMC: 7591371. DOI: 10.1089/dia.2019.0521. View

12.

Balaban R, Zhang F, Vialle-Valentin C, Galbraith A, Burns M, Larochelle M . Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System. J Gen Intern Med. 2017; 32(9):981-989. PMC: 5570741. DOI: 10.1007/s11606-017-4074-2. View

13.

Campbell R . Etiology and effect on outcomes of hyperglycemia in hospitalized patients. Am J Health Syst Pharm. 2007; 64(10 Suppl 6):S4-8. DOI: 10.2146/ajhp070100. View

14.

Klonoff D, Wang J, Rodbard D, Kohn M, Li C, Liepmann D . A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings. J Diabetes Sci Technol. 2022; 17(5):1226-1242. PMC: 10563532. DOI: 10.1177/19322968221085273. View

15.

Cardona S, Gomez P, Vellanki P, Anzola I, Ramos C, Urrutia M . Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes. BMJ Open Diabetes Res Care. 2019; 6(1):e000607. PMC: 6304102. DOI: 10.1136/bmjdrc-2018-000607. View

16.

Mustonen J, Rautiainen P, Lamidi M, Lavikainen P, Martikainen J, Laatikainen T . The use of isCGM leads to marked reduction in severe hypoglycemia requiring emergency medical service or hospital admission and diabetic ketoacidosis in adult type 1 diabetes patients. Acta Diabetol. 2023; 60(7):891-898. PMC: 10198841. DOI: 10.1007/s00592-023-02079-y. View

17.

Jornsay D, Garnett E . Diabetes Champions: Culture Change Through Education. Diabetes Spectr. 2015; 27(3):188-92. PMC: 4523733. DOI: 10.2337/diaspect.27.3.188. View

18.

Solano L . Seven facts you need to know about continuous glucose monitors. JAAPA. 2022; 35(9):41-45. DOI: 10.1097/01.JAA.0000854536.09072.5e. View

19.

. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018; 41(5):917-928. PMC: 5911784. DOI: 10.2337/dci18-0007. View

20.

Shaw J, Stiliannoudakis S, Qaiser R, Layman E, Sima A, Ali A . Thirty-Day Hospital Readmissions: A Predictor of Higher All-cause Mortality for Up to Two Years. Cureus. 2020; 12(7):e9308. PMC: 7440272. DOI: 10.7759/cureus.9308. View