Effect of Continuous Glucose Monitoring Following Hospital Discharge of Patients With Type 2 Diabetes

Context The post-hospitalization period is a vulnerable time for patients with type 2 diabetes (T2D). Objective To assess usefulness of continuous glucose monitoring (CGM) for optimizing glucose levels and supporting medication use and behavioral change. Methods We conducted a prospective, nonrandomized study of hospitalized adults with type 2 diabetes, HbA1c > 8%, and requiring ≥10 units of basal insulin daily. Participants received the Dexcom G6 and had follow-up visits at week 2, 4, 8, and 12 following discharge. The primary focus of analysis was change in HbA1c from 0 to 12 weeks. Secondary outcomes included CGM metrics, remote monitoring capability, and healthcare utilization. Results Among 108 enrolled participants, 51% were monitored remotely, 79% had CGM data post-discharge, and 61% completed the 12-week visit. HbA1c (%) declined from 12% (interquartile range [IQR] 10%, 14%) to 8.2% (IQR 6.9%, 9.3%) (P < .0001). Time in glucose range 70 to 180 mg/dL (TIR) increased from 37% (IQR 17, 61) at 2 weeks to 43% (IQR 14, 86) at 12 weeks (P = .03). Among participants with endpoint HbA1c values, those with CGM data at all 4 visits, (44/60, 73%) had similar HbA1c, tended to be readmitted within 12 weeks less often (23% vs 50%, P = .06), and were more likely to have endocrinology follow-up (49% vs 6%, P = .003). Remote and manual monitoring groups had similar availability of CGM data, TIR, hypoglycemia, and healthcare utilization. Conclusion Initiating CGM at hospital discharge was feasible, safe, and associated with significant glycemic improvement at 12 weeks. Additional studies are needed to optimize the implementation of CGM following discharge.