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PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge

BACKGROUND: Use of inpatient continuous glucose monitoring (CGM) has increased during the COVID-19 pandemic. The objective of this study was to evaluate outpatient follow-up patterns and readmission rates for patients discharged from the hospital with CGM. RESEARCH DESIGN AND METHODS: We retrospecti...

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Autores principales: Barnett, Anne, Chiruvella, Varsha, Elshimy, Ghada, Grimm, Jenny, Healy, Sara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624938/
http://dx.doi.org/10.1210/jendso/bvac150.800
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author Barnett, Anne
Chiruvella, Varsha
Elshimy, Ghada
Grimm, Jenny
Healy, Sara
author_facet Barnett, Anne
Chiruvella, Varsha
Elshimy, Ghada
Grimm, Jenny
Healy, Sara
author_sort Barnett, Anne
collection PubMed
description BACKGROUND: Use of inpatient continuous glucose monitoring (CGM) has increased during the COVID-19 pandemic. The objective of this study was to evaluate outpatient follow-up patterns and readmission rates for patients discharged from the hospital with CGM. RESEARCH DESIGN AND METHODS: We retrospectively identified patients with diabetes (DM) aged >18 years who were admitted between 3/27/20 and 5/13/21 and received Freestyle Libre or Freestyle Libre 2 14-day sensor at the time of discharge from the hospital. The sensor was placed in the hospital by our diabetic educator. Only the first admission was included. The medical record was reviewed to determine attendance at outpatient follow-up visit, CGM downloading and prescribing at that visit, and readmission within 30 days. RESULTS: 87 patient charts were analyzed (31% type 1 DM, 66% type 2 DM, 3% other). The most common reasons for CGM placement were patients new to insulin (40%), DKA (34%), new diabetes diagnosis (30%), or HHS (5%). Follow-up information was not available for 25 patients (29%). The remaining 62 patients had scheduled follow-up within our system. 42 of those patients (68%) attended their follow-up appointment while 14 patients (33%) attended follow-up in an endocrine clinic. Among the 42 patients who attended follow-up, 8 patients (19%) had CGM data downloaded and 18 patients (43%) were prescribed CGM. Of the patients who attended endocrine follow-up, 50% had CGM downloads, compared to only 4% of patients seen in non-endocrine clinics (p = 0.001). Similarly, 79% of patients with endocrine follow-up were prescribed CGM sensors, while 25% of patients seen in non-endocrine clinics received a CGM prescription (p = 0.001). For patients newly diagnosed with DM and available follow-up data, 89% (N=16) attended their appointment. Overall, 16% of patients were readmitted within 30 days. Of the patients readmitted, only 17% attended outpatient follow-up and none had CGM downloaded or prescribed. Backward binary logistic regression was used to assess the relationship between outcomes (follow-up attendance and readmission) and variables (including diagnosis and follow-up location) in the 62 patients with follow-up data. In the final models, a new diagnosis of DM was associated with follow-up attendance, and type 1 DM and follow-up nonattendance were associated with 30-day readmission. Results were verified using exact logistic regression. CONCLUSIONS: Downloading and prescribing of CGM after hospital discharge occurred in less than half of patients, but occurred more frequently in endocrine clinics. A specialized transition of care clinic may benefit patients discharged with CGM. Follow-up attendance among readmitted patients was poor. Patients with a new diagnosis of DM had good follow-up attendance and may be good candidates for CGM at hospital discharge, which can be examined in future prospective studies. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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spelling pubmed-96249382022-11-14 PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge Barnett, Anne Chiruvella, Varsha Elshimy, Ghada Grimm, Jenny Healy, Sara J Endocr Soc Diabetes & Glucose Metabolism BACKGROUND: Use of inpatient continuous glucose monitoring (CGM) has increased during the COVID-19 pandemic. The objective of this study was to evaluate outpatient follow-up patterns and readmission rates for patients discharged from the hospital with CGM. RESEARCH DESIGN AND METHODS: We retrospectively identified patients with diabetes (DM) aged >18 years who were admitted between 3/27/20 and 5/13/21 and received Freestyle Libre or Freestyle Libre 2 14-day sensor at the time of discharge from the hospital. The sensor was placed in the hospital by our diabetic educator. Only the first admission was included. The medical record was reviewed to determine attendance at outpatient follow-up visit, CGM downloading and prescribing at that visit, and readmission within 30 days. RESULTS: 87 patient charts were analyzed (31% type 1 DM, 66% type 2 DM, 3% other). The most common reasons for CGM placement were patients new to insulin (40%), DKA (34%), new diabetes diagnosis (30%), or HHS (5%). Follow-up information was not available for 25 patients (29%). The remaining 62 patients had scheduled follow-up within our system. 42 of those patients (68%) attended their follow-up appointment while 14 patients (33%) attended follow-up in an endocrine clinic. Among the 42 patients who attended follow-up, 8 patients (19%) had CGM data downloaded and 18 patients (43%) were prescribed CGM. Of the patients who attended endocrine follow-up, 50% had CGM downloads, compared to only 4% of patients seen in non-endocrine clinics (p = 0.001). Similarly, 79% of patients with endocrine follow-up were prescribed CGM sensors, while 25% of patients seen in non-endocrine clinics received a CGM prescription (p = 0.001). For patients newly diagnosed with DM and available follow-up data, 89% (N=16) attended their appointment. Overall, 16% of patients were readmitted within 30 days. Of the patients readmitted, only 17% attended outpatient follow-up and none had CGM downloaded or prescribed. Backward binary logistic regression was used to assess the relationship between outcomes (follow-up attendance and readmission) and variables (including diagnosis and follow-up location) in the 62 patients with follow-up data. In the final models, a new diagnosis of DM was associated with follow-up attendance, and type 1 DM and follow-up nonattendance were associated with 30-day readmission. Results were verified using exact logistic regression. CONCLUSIONS: Downloading and prescribing of CGM after hospital discharge occurred in less than half of patients, but occurred more frequently in endocrine clinics. A specialized transition of care clinic may benefit patients discharged with CGM. Follow-up attendance among readmitted patients was poor. Patients with a new diagnosis of DM had good follow-up attendance and may be good candidates for CGM at hospital discharge, which can be examined in future prospective studies. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m. Oxford University Press 2022-11-01 /pmc/articles/PMC9624938/ http://dx.doi.org/10.1210/jendso/bvac150.800 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetes & Glucose Metabolism
Barnett, Anne
Chiruvella, Varsha
Elshimy, Ghada
Grimm, Jenny
Healy, Sara
PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title_full PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title_fullStr PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title_full_unstemmed PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title_short PSUN229 Transitions of Care and Readmissions in Patients with Diabetes Receiving CGM at Hospital Discharge
title_sort psun229 transitions of care and readmissions in patients with diabetes receiving cgm at hospital discharge
topic Diabetes & Glucose Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624938/
http://dx.doi.org/10.1210/jendso/bvac150.800
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