Diabetes Mellitus, Type 2
Conditions
Keywords
hospital discharge, Continuous Glucose Monitoring, Type 2 diabetes, rehospitalization
Brief summary
Intervention group will receive brief diabetic education, CGM education and use and have a CGM placed before discharge. They will also sign up for Cloud access of their CGM data. A medical assistant will review their CGM data daily to make sure they are using the CGM adequately. The principal investigator will review the CGM data and call the patient for a brief phone evaluation of their glucoses and their transition from the hospital to outpatient care. The will be called 4 times between discharge and day 15 by the principal investigator. Standard treatment group will receive a blinded CGM to be reviewed 30 days after discharge. Reduction in hospitalizations and ER visits within the first 30 days is the primary outcome. Time in range, hypoglycemia, hyperglycemia and patient satisfaction will also be evaluated 30 days after discharge.
Detailed description
Patients admitted to a community hospital with diabetes will be evaluated for being high risk for rehospitalization. High risk patients will be identified and those that are found to be high risk will be evaluated for entrance to the study and consented. Those that consent will be randomized to two arms, an intervention arm and a standard care arm with CGM monitoring. Intervention will include a brief 15 minute diabetic education session and a 15 minute brief education on how to use the Freestyle Libre CGM. A sensor will be placed and initiated before discharge. They will also sign up for a Freestyle Libre View account and grant access to the intervention team. The will receive a handout of reasons to call the principal investigator during the first 15 days and will be told to access the PI through the hospital operator. The PI will call the patient on day 3-4, day 5-6, day 9-10 and day 14-15 after reviewing their CGM data. The PI will review their glucoses and also any concerns from their hospitalization. The team can then help bridge any treatment or care gaps with the patients PCP or care team. The CGM data will be recorded for the first 14 days and data will be sent to the PCP. The standard treatment arm will get 15 minutes of education on how to use the Libre Pro blinded CGM sensor and the sensor will be placed before discharge. The sensor will be sent back the the team and downloaded. After 30 days the data will be sent to the patients PCP. Outcomes will be measured for 30 days from discharge. Patient satisfaction will be measured by a phone interview in both groups once after 31-40 days from discharge
Interventions
DEVICECGM device with diabetic education, CGM education and a follow up protocol.
Blind CGM placed and recorded for 14 days after discharge and data downloaded
Sponsors
Abbott
Intermountain Health Care, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
Data evaluation group will be blinded as to which arm the data comes from
Intervention model description
Prospective Randomized Trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Type 2 diabetes plus one additional criteria during hospitalization: A1C greater than or equal to 9, New diagnosis of diabetes Type 2 and A1C greater than or equal to 8, On insulin, On sulfonylurea, Deemed to by high risk by hospitalist staff for post-hospitalization complications, Acute Heart Failure, Acute Coronary Syndrome (ACS), Stroke, or a TIA. \-
Exclusion criteria
Type 1 Diabetes, or Not high risk (as above), or Already using a CGM, or Unable to understand or use a CGM, or Unable or unwilling to use a CGM, or Participating in another clinical trial within 30 days. \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency room visit and rehospitalization | Within 30 days after discharge from the hospital | Total Emergency room visits and total rehospitalizations |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rehospitalizations | Within 30 days after discharge from the hospital | Total Rehospitalizations |
| Time in range | From discharge to day 14 | percent of time glucose is in range from 70-180 mg/dl as measured by CGM |
| time in hypoglycemia | from discharge through day 14 | amount of time below 70 mg/dl as measured by CGM |
| Emergency room visits | Within 30 days after discharge from the hospital | Total Emergency room visits |
| time in hyperglycemia | From discharge through day 14 | glucose from 181-250 mg/dl as measured by CGM |
| time in severe hyperglycemia | from discharge through day 14 | glucose greater than 251 mg/dl as measured by CGM |
| Patient satisfaction | survey will be done between 31 and 40 days after hospital discharge | Patient telephone questionnaire about patient satisfaction during the transition phase |
| Severe hypoglycemia | from discharge to day 30 | hypoglycemia requiring the assistance from another person |
Countries
United States
Outcome results
None listed