Hospitalization is an opportunity for initiation and reevaluation of diabetes management. Many inpatients are either found to have new hyperglycemia or suboptimal glucose control, necessitating the initiation or titration of insulin. Blood glucose monitoring has traditionally been used with insulin therapy. Continuous glucose monitoring (CGM) of interstitial fluid has gained favor as an effective means to achieve this end. We studied the impact of early institution of CGM in the hospital and continuing post-discharge in insulin-treated patients over a 6-month time period. The initiative was shepherded by a newly-established academic endocrinology practice consisting of a diabetes specialist and a nurse clinician. Focused inpatient diabetes teaching, followed by formal outpatient education delivered by certified educators, was employed. 47 patients (31 males, 16 females; average age 63.3 years) were either begun or progressed to intensive insulin therapy (2-4 daily injections), coupled with CGM use (Freestyle Libre or Dexcom G6) within 2 weeks of discharge. Patients used blood glucose meter readings as needed. Downloaded CGM data with ambulatory glucose profile was reviewed for each patient proactively at least once a month. Patients were advised of changes in insulin/diabetes therapy by phone or electronic portal, and during telehealth and in-person office visits. The average time-in-range (TIR) increased from 59.6% to 60.9% (p= 0.5), while the average hemoglobin A1c decreased from an inpatient value of 9.8% to 7.4% (p<0.05) over a mean period of 6 months. The CGM continuation rate was close to 100%. We conclude that with availability of expertise and clinical support, CGM and its interactive technology offers a unique tool to improve glucose control and empower insulin-treated outpatients in the critical post-hospitalization time. It would be expected to result in better outcomes with regard to complications, readmission rates, and cost of care.
A. A. Rizvi: None. C. Eberlein: None.
