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

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.

Trial registration: ClinicalTrials.gov NCT00869362.

Figure 1. Consort Diagram

Figure 2

a. HbA1c up to 12 months after hospital discharge in all subjects. Linear mixed model including fixed effects of treatment group, treatment times visit interaction, and random participant-specific intercepts and slopes over time; P value for overall difference between groups=0.3. b. HbA1c up to 12 months after hospital discharge in patients not treated with insulin prior to hospital admission (“insulin-naïve”). Linear mixed model including fixed effects of treatment group, treatment times visit interaction, and random participant-specific intercepts and slopes over time; P value for overall difference between groups=0.04.

Figure 2

a. HbA1c up to 12 months after hospital discharge in all subjects. Linear mixed model including fixed effects of treatment group, treatment times visit interaction, and random participant-specific intercepts and slopes over time; P value for overall difference between groups=0.3. b. HbA1c up to 12 months after hospital discharge in patients not treated with insulin prior to hospital admission (“insulin-naïve”). Linear mixed model including fixed effects of treatment group, treatment times visit interaction, and random participant-specific intercepts and slopes over time; P value for overall difference between groups=0.04.