An Individualized Inpatient Diabetes Education and Hospital Transition Program for Poorly Controlled Hospitalized Patients with Diabetes.
Endocr Pract. 2014 Aug 6;:1-24
Authors: Dungan K, Lyons S, Manu K, Kulkarni M, Ebrahim K, Grantier C, Harris C, Black D, Schuster D
Objective: To evaluate predictors of outcomes associated with an inpatient diabetes education and discharge support program for hospitalized patients with poorly controlled diabetes (HbA1c>9%).Methods: Patients participated in individualized diabetes education conducted by a certified diabetes educator (CDE), exploration of barriers, and goal setting during hospitalization with phone follow-up and communication to primary providers at discharge. Predictors of HbA1c reduction, successful follow-up, and readmission were analyzed.Results: There were 82 subjects total, and 48% were insulin naive. Patients with Type 2 diabetes (T2D, N=58) had a significant decrease in HbA1c at follow-up (-2.8%, p-value: <0.0001), while those with Type 1 diabetes (T1D, N=19) did not (+0.02%, p-value: 0.96). After adjustment for other factors however, only increasing age, higher baseline HbA1c, earlier education, and initiation of basal insulin were significant predictors of reduction in HbA1c. Higher area level income and empowerment, and earlier education were significant predictors of outpatient follow-up within 30 days. While 28% were admitted for severe hyperglycemia, only one patient was readmitted with severe hyperglycemia. Successful phone contact was 77% and 57% with and without the support of non-CDE assistants respectively, but all outcomes were similar.Conclusion: The study suggests that an individualized inpatient diabetes education and transition program is associated with a significant reduction in HbA1c that is dependent on baseline HbA1c, older age, initiation of insulin, and earlier enrollment. Additional interventions are needed to ensure better continuity of care.
PMID: 25100371 [PubMed - as supplied by publisher]