Remote Patient Monitoring With Continuous Glucose Monitoring Improves Glycemic Outcomes in Patients With Type 2 Diabetes at a Safety-Net Hospital.
Academic Article
Overview
abstract
OBJECTIVE: The Bronx has a high prevalence of type 2 diabetes mellitus (T2DM) but limited primary care access, delaying evaluation and treatment. Remote patient monitoring (RPM) with continuous glucose monitoring (CGM) may improve outcomes in T2DM. We evaluated whether RPM with CGM improved hemoglobin A1c (HbA1c) compared to standard care at our safety-net hospital. METHODS: This retrospective cohort study compared a pilot RPM diabetes program to a control cohort receiving standard care. RPM and control patients were ≥18 years old with T2DM and had HbA1c >8.5% (69 mmol/mol), and basal insulin and CGM prescriptions. Participants had monthly telemedicine visits with an endocrine specialist for 3-6 months. Patients unable or unwilling to use telemedicine or CGM were excluded. Primary outcome was change in HbA1c from baseline to repeat HbA1c at 2-6 months. A multivariable logistic regression model adjusted for baseline HbA1c and demographics. RESULTS: The RPM (n = 41) and control (n = 766) cohorts had mean baseline HbA1c of 10.5 ± 1.4% (91 ± 15.6 mmol/mol) and 10.6 ± 1.7% (92 ± 18.8 mmol/mol), respectively. At follow up, HbA1c decreased by 3.0% (32.9 mmol/mol) in the RPM group vs 2.1% (22.4 mmol/mol) in controls (P = .004). A goal HbA1c <7.5% (58 mmol/mol) was achieved in 58.5% of RPM patients vs 36.2% of controls (OR 2.53, 95% CI 1.31 - 4.88, P < .01). Most frequent medication adjustments occurred with insulin, glucagon-like peptide-1, and glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide. CONCLUSION: RPM with CGM improved glycemic control in T2DM in an under-resourced setting, compared to standard care. Further research is needed to explore implementation on a larger scale.
