JMIR Publications

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 of CGM would be acceptable on discharge and if CGM initiated on hospital discharge in people with type 2 diabetes, would reduce hospital re-presentations at one month.

Methods:

This was an open label study. Adult inpatients with T2DM, who were to be discharged home, who required post-discharge glycaemic 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 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 randomised to active arm or usual care control group.

Results:

Of 237 patients screened during their hospital admission 34 had co-morbidities affecting cognition that prevented informed consent and affected ability to learn to use the CGM device; 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 towards 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 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 require more novel implementation frameworks. Clinical Trial: Ethics approval was granted by SESLHD Human Ethics committee (18/263 HREC/19/POWH/102).