Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

Abstract

Background: Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting.

Methods: This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital.

Results: Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation (P = .02); no such time effect was seen prior to IDMS (P = .34). LOS and 30DRR were not significantly different between IDMS models.

Conclusions: Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.

Keywords: diabetes; hospitalist; hyperglycemia; inpatient; length of stay; readmissions.

Figure 1.

IDMS monthly patient volume. Diabetes patient days per month seen by the HCGH Inpatient Diabetes Management Service (IDMS): local private outpatient endocrine service (black bars), dedicated inpatient Endocrine Hospitalist (grey bars), and Endocrine Hospitalist + Endocrine Nurse Practitioner (white bars). Striped bars represent an overlap between two services for that month.

Figure 2.

Inpatient hyperglycemia. Rates of inpatient hyperglycemia (defined as % of patient days with a mean blood glucose >180 mg/dL) among patients with diabetes. (A) Seen by IDMS. (B) Not seen by IDMS. Black circles: local private outpatient endocrine service, grey circles: dedicated inpatient Endocrine Hospitalist, white circles: Endocrine Hospitalist + Endocrine Nurse Practitioner. Striped circles represent an overlap between two services for that month. Linear regression lines shown for the time periods January 2017 to July 2018 and September 2018 to August 2020. Among patient seen by the endocrine service, overall hyperglycemia decreased from 53.8% (outpatient endocrine service) to 42.5% (Endocrine Hospitalist; p<.0001). Hyperglycemia decreased significantly with time for patients not seen by IDMS in the 24 months post-IDMS (P < .001 for slope different from zero).

Figure 3.

Inpatient hypoglycemia. Rates of inpatient mild (glucose <70 mg/dL), moderate (≤54 mg/dL), and severe (<40 mg/dL) hypoglycemia among patients with diabetes seen by IDMS. Black shapes: local private outpatient endocrine service, grey shapes: dedicated inpatient Endocrine Hospitalist, white shapes: Endocrine Hospitalist + Endocrine Nurse Practitioner. Striped shapes represent an overlap between two services for that month. Linear regression lines shown for the time periods January 2017 to July 2018 and September 2018 to August 2020. Mild hypoglycemia decreased significantly with time for patients seen by IDMS in the 24 months post-IDMS time period (P = .02 for slope different from zero).