Understanding Glycemia in the Post Discharge Period Through Blinded Continuous Glucose Monitoring.

OBJECTIVE

Transitions of care at hospital discharge are critical time periods for people with diabetes, but little is known about glycemia in the immediate postdischarge period.

METHODS

In this observational study, participants wore blinded Dexcom G6 Pro CGM during hospital admission on nonintensive care floors and then continued wearing blinded continuous glucose monitoring (CGM) for up to 10 days posthospital discharge. Clinical data were extracted from the electronic medical record. Percent time in range 70-180 mg/dl (TIR), above range, and below range from the inpatient and postdischarge periods were calculated. The percentage of participants achieving TIR ≥50% and ≥70%, incidence of hypoglycemia after discharge, change in inpatient and postdischarge CGM metrics, and predictors of postdischarge glycemia were determined.

RESULTS

A total of 24 adults (mean age 65.7 ± 13.6 years, 37.5% female) wore CGM after discharge with mean TIR 43.9 ± 33.2%, mean time above range 55.9 ± 33.3%, and median time below range 0% (0, 0.04). Of these participants, 41.7% had TIR ≥50%, and 29.2% had TIR ≥70%. Glycemia predischarge and postdischarge was similar (postdischarge vs inpatient TIR -3.7 ± 22.5%, P = .4). Of the clinical factors assessed, only inpatient glycemia was associated with achieving postdischarge glycemic targets. CGM detected 13 episodes of hypoglycemia occurring in 6 participants (25%) postdischarge.

CONCLUSIONS

Glycemia during the postdischarge period is suboptimal and glucose levels in the hospital may be an important predictor of glycemia after hospitalization. CGM may be useful in identifying hypoglycemia after discharge. Further studies are needed to understand the utility of CGM after hospital discharge.