Piloting a Postdischarge Virtual Glucose Monitoring Program for Patients With Diabetic Foot Wound in a Safety-Net Health System

Background: Diabetic foot wounds disproportionately affect patients from ethnic minorities and lower-socioeconomic status, many of whom face barriers to accessing diabetes technology. To evaluate whether short-term virtual glucose monitoring (VGM) has the potential to improve clinical outcomes in this high-risk population, we implemented a pilot VGM program within a safety-net health system. Method: We enrolled 40 hospitalized patients with diabetic foot wounds into a 3-month postdischarge VGM program that included 2 clinic visits and remote glucose monitoring every 1 to 2 weeks. Clinical outcomes were compared with a retrospective preintervention cohort of 78 similar patients. Results: Although both groups had similar HgbA1c at diagnosis (VGM 10.6 ± 1.8% vs preintervention 11.1 ± 2.0%, P = .20), the HgbA1c at 3 to 6 months was lower in the VGM cohort (7.6 ± 1.1% vs 8.5 ± 2.0%, P < .01). Wound healing occurred more frequently in the VGM participants, with 68% achieving wound closure by 3-4 months versus only 47% in the preintervention cohort ( P = .04). Nonsignificant reductions in emergency department visits and hospital readmissions for wound complications or hypoglycemia were observed in the VGM versus the preintervention cohort. The VGM program allowed for more timely and frequent opportunities to adjust diabetes medications and address social barriers to care. Conclusions: A short-term postdischarge VGM program has the potential to not only increase access to diabetes technology but also meaningfully improve clinical outcomes among patients with diabetic foot wounds in a safety-net health setting. Such program may offer a scalable strategy to reduce rates of complications and lower healthcare costs in a safety-net health system.