Hospital discharge a terrible time to initiate CGM, researchers find

Research

By Geir O'Rourke

3 Feb 2023

Hospital discharge is a poor time to attempt initiation of CGM because patients will be too overwhelmed or stressed, researchers have advised.

It follows a failed attempt to run a study at the Prince of Wales Hospital in Sydney with adult patients requiring postdischarge glycemic stabilisation.

Staff at the hospital spent five months attempting to recruit patients for the trial, planning to give half a CGM device and examine whether the technology would reduce short term re-presentations.

The idea was to recruit 440 patients who met inclusion criteria of being adult inpatients with T2DM, who were to be discharged home and required postdischarge glycemic stabilisation.

Those with other forms of diabetes or who were unable to provide consent were excluded.

But although 101 eligible patients were identified, staff were only able to convince 19 to sign up, the researchers wrote in JMIR Diabetes.

“Due to poor recruitment, the study was terminated without entering the randomisation phase to determine whether CGM could reduce readmission rates,” they wrote.

The researchers noted that, of the 82 patients who declined to participate, 31 advised that learning a new task toward discharge was “overwhelming or too stressful” given the time and place.

Another 26 said they were not interested, no other details.

“Acute illness and transitioning home is a stressful time for a person and their support network, and so may not be a suitable time to introduce new diabetes self-management tasks,” the authors said.

“This is in addition to limited access to technology and telemedicine ‘unreadiness’ being high among older adults.”

They stressed that results were positive among the few patients they were able to sign up, with just two out of the 19 participants having an unplanned hospital re-presentation in the first month of discharge.

Supported via telehealth, 16 of the 19 patients also reported being satisfied with their CGM devices, the authors said.

While it was clear that patients were unlikely to embrace complex new technology on exit from hospital, the sample size was too small for any broader conclusions to be drawn, they said.

It came after both major parties pledged to expand funding for CGM products during the federal election campaign.

Diabetes groups welcomed the pledge, expected to subsidise devices for up to 71,000 additional patients from July, but argued more support was needed to address discontinuation rates.

“Access to a device is only part of the picture,” Australian Diabetes Educators Association CEO Susan Davidson told the limbic last month.

“Many patients will need additional sessions with diabetes educators and endocrinologists to ensure they are comfortable with the technology, plus after-hours support which currently isn’t funded in any way.”

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