Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge

• Published in: Diabetes research and clinical practice 2012-11, Vol.98 (2), p.249-256
• Main Authors: Wexler, Deborah J, Beauharnais, Catherine C, Regan, Susan, Nathan, David M, Cagliero, Enrico, Larkin, Mary E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Glucose - drug effects; Diabetes care management strategy; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Endocrinology & Metabolism; Female; Glycated Hemoglobin - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Inpatient diabetes management; Inpatient to outpatient transitions in care; Inpatients - statistics & numerical data; Insulin - therapeutic use; Male; Middle Aged; Patient Discharge
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2012.09.016

Abstract Aim To determine whether inpatient diabetes management and education with improved transition to outpatient care (IDMET) improves glycemic control after hospital discharge in patients with uncontrolled type 2 diabetes (T2DM). Methods Adult inpatients with T2DM and HbA1c > 7.5% (58 mmol/mol) admitted for reasons other than diabetes to an academic medical center were randomly assigned to either IDMET or usual care (UC). Linear mixed models estimated treatment-dependent differences in the change in HbA1c (measured at 3, 6, and 12 months) from baseline to 1-year follow-up. Results Thirty-one subjects had mean age 55 ± 12.6 years, with mean HbA1c of 9.7 ± 1.6% (82 ± 18 mmol/mol). Mean inpatient glucose was lower in the IDMET than in the UC group (176 ± 66 versus 195 ± 74 mg/dl [9.7 versus 10.8 mmol/l], P = 0.001). In the year after discharge, the average HbA1c reduction was greater in the IDMET group compared with the UC group by 0.6% (SE 0.5%, [7 (SE 5) mmol/mol], P = 0.3). Among patients newly discharged on insulin, the average HbA1c reduction was greater in the in the IDMET group than in the UC group by 2.4% (SE 1.0%, [25 (SE 11) mmol/mol], P = 0.04). Conclusions Inpatient diabetes management (IDMET) substantially improved glycemic control 1 year after discharge in patients newly discharged on insulin; patients previously treated with insulin did not benefit.