Remote monitoring for patients with a variety of diseases has been on the increase since the emergence of the COVID pandemic.

While hypertension is the leading diagnosis for monitoring, diabetes is not far behind, fueled by continuous glucose monitoring (CGM), new reimbursement pathways, and growing pressure to prevent avoidable admissions. Clinicians report mixed results, though: Some programs reduce acute events and stabilize patients post-discharge, while others generate more data than the care team can reasonably act on.

Across these varied experiences, two questions continue to dominate for primary care physicians and hospitalists: which remote monitoring models actually reduce hospitalizations, emergency department (ED) visits, and readmissions, and which simply add to the workload?

A Shared Core Architecture

Many clinicians describe remote monitoring programs as either highly effective or overwhelmingly burdensome, and the difference, experts say, has very little to do with the hardware.

“The programs that move the needle share three features: structured workflows, proactive outreach, and authority to adjust medications. The device alone doesn’t do it,” said Fady Hannah-Shmouni, MD, medical director at Eli Health.

Hannah-Shmouni gave examples of several structures in which different delivery systems have delivered measurable, documented reductions in acute events, ED visits, and hospitalizations.

The first category includes CGM programs tied to structured follow-up for insulin-treated type 2 diabetes, including periodic review and patient education. Second is telemonitoring models with defined care teams that include scheduled virtual visits, diabetes educator or pharmacist oversight, and protocol-driven titration, that produces similar improvements. Third, commercial platforms that combine connected glucose devices, algorithmic triage, and coaching services that also demonstrate reductions in diabetes-related utilization and total medical spending.

Finally, Hannah-Shmouni cited nurse- or educator-led monitoring programs for high-risk groups such as pediatric patients. He said these all succeed because they rely on consistent workflows and clearly defined intervention thresholds.

Ashley Kowalski, RN, head of clinical innovation at Brentwood, Tennessee-based chronic care management company CareHarmony, said the synergy of CGM plus remote patient monitoring (RPM) is what produces the strongest results. 

“Adding CGMs alone has been shown to improve outcomes, reduce the cost of care, and prevent unnecessary utilization. When CGMs are paired with remote patient monitoring, the impact becomes even stronger,” she said. “RPM not only provides additional reimbursement to cover the labor costs of a clinician reviewing CGM data in real time but it also allows for much more nimble responses when changes occur.”

In community health settings, CGM can be a tool for acceptance and engagement as well as clinical management.

“I’ve seen CGM work with patients struggling to accept the diagnosis of diabetes, for example, by assisting patients to correlate high or low blood sugar with experienced symptoms. This helps to motivate individuals to learn more about blood sugar management and ways to improve their health,” said Monica Harmon, MPH, RN, a Philadelphia-based community health consultant who served as the longtime director of the Community Wellness HUB at Drexel University, Philadelphia.

By contrast, Hannah-Shmouni said that programs lacking structure rarely generate meaningful impact.

“Programs that simply hand out devices, collect data without clear thresholds, or lack authority to change therapy rarely show meaningful changes in admissions or ED use,” he said.

From Data to Action: Clear Triggers Bridge the Gap

Gathering data is the easy part. Determining what to do with it — and taking action consistently — is what differentiates successful RPM from background noise.

“You need tiered, predefined triggers, not just a dashboard,” Hannah-Shmouni said.

He said severe hypoglycemia, rapidly falling glucose readings, or sustained low values should prompt immediate alerts, rapid confirmation, direct patient outreach, and escalation as appropriate.

Recurrent or nocturnal lows typically require several days of observation followed by targeted education or medication adjustments. Hyperglycemia follows the same pattern: symptoms, severity, and persistence dictate urgency.

Kowalski said focusing on trends, not isolated numbers, is essential. She said a single elevated reading is often tied to meals or stress, but gradual upward or downward drift over days should prompt intervention and added that RPM is most effective when patients are taught to recognize their own trends and understand how their behaviors influence them.

In community health environments, triggers must be interpreted through the lens of social determinants.

Social determinants of health compound the use of remote monitoring in diabetes management, Harmon said.

“If someone is housing or food insecure, stress levels increase, thus raising blood sugar,” she said. “Plus, if there is insufficient WiFi or access to electricity for charging these devices, the signals cannot be transmitted, or refrigeration of medicines cannot occur.”

Harmon said that in some cases, literacy and digital literacy remain barriers to participation.

High-Risk Patients Drive Utilization Reductions

Not all patients benefit equally from remote monitoring, and broad enrollment often dilutes a program’s effectiveness.

“Vendors often promise population-wide improvement, but in practice, most of the benefit is concentrated in high-risk patients: those who are insulin-treated, very high A1c, recent DKA [diabetic ketoacidosis] or severe hypoglycemia, pregnancy, or who have advanced CKD [chronic kidney disease],” he said. “For lower-risk patients, you may see better numbers without a meaningful change in ED or hospital use.”

The drawbacks to using these programs across a wider spectrum of patients can include “alert fatigue,“ with too many non-actionable notifications, weak alignment with clinic workflows, and another inbox that someone has to manage, he said.

Hannah-Shmouni also said that the cost-benefits analysis gets more difficult when adding more patients into the mix.

“Reductions in hospitalizations and cost are often hard to prove over short time frames and can be confounded by other changes in care,” he said. “Meanwhile, costs — devices, subscriptions, staff time, training — are immediate, and savings may accrue to payers or health systems rather than to the clinic doing the work.”

Accordingly, Hannah-Shmouni said long-term success with a remote monitoring program depends less on the technology or algorithms behind the system and more on targeting the right patients, building clear workflows and thresholds, empowering teams to adjust therapy, and aligning incentives so that the clinical effort is actually supported.

Postdischarge Stabilization: Structured Oversight Reduces Bouncebacks

The transition home after hospitalization is a particularly vulnerable period for glycemic instability. Hospital data from the past decade consistently show that adults with diabetes face high rates of early return to care, including studies from 2015 and 2017 that found that about 1 in 5 hospitalized adults with diabetes were readmitted within 30 days.

More recent analyses indicate that these numbers have changed little. Centers for Medicare and Medicare and Medicaid Services claims data typically place 30-day readmission rates in the 18%-23% range for patients discharged with either a primary or secondary diagnosis of diabetes.

A 2024 study in the Brazilian journal Einstein showed that in a retrospective cohort of adults enrolled in a hospital diabetes program, postdischarge telemonitoring was associated with a 15% lower readmission rate compared with similar patients who did not receive telemonitoring. The largest reductions in readmissions were in younger and very old adults and those with longer initial stays.

Hannah-Shmouni said remote monitoring can help ensure stability if applied with rigor.

“The successful strategies treat the first 2-4 weeks post-discharge as a high-touch ‘landing zone,’” Hannah-Shmouni said. “Effective programs establish device connectivity before discharge, schedule structured follow-up visits, designate a single clinical leader, and use early data to simplify regimens and prevent predictable failures.”

In the community care setting, Harmon said simple outreach strategies play an outsized role.

“Follow-up phone calls and text messages are helpful,” she said. “Even when patients cannot reply, they still receive reminders and clarifications that reinforce discharge instructions.”

Hannah-Shmouni, Harmon, and Kowalski reported having no disclosures.