Dr Spiros Fourlanos
Early identification and specialised management of patients with diabetes in hospital for a wide range of non-critical medical and surgical conditions has been shown to improve patient outcomes.
In a study of more than 1,000 people with diabetes admitted to the Royal Melbourne Hospital, a proactive model of care for patients with diabetes was compared with usual care.
The intervention included assessment by a specialist inpatient diabetes team within 24 hours of admission and a structured clinical escalation pathway.
At the ward level, the 12-week intervention resulted in a significant decrease from baseline in the incidence of adverse glycaemic days (AGDs) defined by blood glucose <4 or >15 mmol/L.
“Comparing parallel treatment groups during the active period, the number of AGDs per patient was 23% lower (95% CI 6– 40%, P = 0.008) in the intervention arm than in the control arm,” the study found.
The patient-day mean glucose decreased from 9.4 to 9.0 mmol/L in the intervention arm (p = 0.003) but was stable in the control arm (9.6 to 9.5 mmol/L, p=0.235).
There was a 55% decrease in the proportion of patient-days with a mean glucose over 15 mmol/L in the intervention arm, with no change in the control arm. There was no change in the incidence of hypoglycemia in either arms.
Hospital acquired infections decreased significantly from 6.4% to 2.4% (p=0.035) in the intervention arm but not in the control arm (8.6 to 7.0%, p=0.61). The number needed to treat (NNT) to prevent one hospital-acquired infection was 25.
Lead researcher, endocrinologist Associate Professor Spiros Fourlanos told the limbic the study represented the largest cluster randomised controlled trial of inpatients with diabetes in the world.
“Our purpose was to see if we could prove that there were real clinical benefits, and the next step in regards to feasibility would be to not necessarily see everybody with diabetes but to focus our efforts and resources on people at the highest risk for adverse glycaemic days and the highest risk for adverse outcomes related to their diabetes.”
“We feel this intervention was able to successfully demonstrate better and safer care for people with diabetes in hospital.”
He said that patients very much welcomed the intervention given that inadequate attention to systematic care of diabetes in hospital was a recurring theme.
“Here, they had a direct line of communication with a health professional who was helping to oversee their diabetes management. So it was very well received and the feedback we have had from patients has been highly positive.”
He added that the intervention was also well received by clinical colleagues managing the patients’ reasons for admission.
“The reality was that it was well received by our colleagues with genuine appreciation of assistance with managing diabetes given that diabetes now affects about one-third of the inpatient population.”
“There are now up to 10 different medication classes and 40 different diabetes medications which means the complexity of inpatient care in diabetes is great and therefore any assistance is appreciated.”