Early Intervention for Diabetes in Medical and Surgical Inpatients Decreases Hyperglycemia and Hospital-Acquired Infections: A Cluster Randomized Trial

Abstract

OBJECTIVE To investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care. RESEARCH DESIGN AND METHODS We investigated a proactive or early intervention model of care (whereby an inpatient diabetes team electronically identified individuals with diabetes and aimed to provide bedside management within 24 h of admission) compared with usual care (a referral-based consultation service). We conducted a cluster randomized trial on eight wards, consisting of a 10-week baseline period (all clusters received usual care) followed by a 12-week active period (clusters randomized to early intervention or usual care). Outcomes were adverse glycemic days (AGDs) (patient-days with glucose <4 or >15 mmol/L [<72 or >270 mg/dL]) and adverse patient outcomes. RESULTS We included 1,002 consecutive adult inpatients with diabetes or new hyperglycemia. More patients received specialist diabetes management (92% vs. 15%, P < 0.001) and new insulin treatment (57% vs. 34%, P = 0.001) with early intervention. At the cluster level, incidence of AGDs decreased by 24% from 243 to 186 per 1,000 patient-days in the intervention arm (P < 0.001), with no change in the control arm. At the individual level, adjusted number of AGDs per person decreased from a mean 1.4 (SD 1.6) to 1.0 (0.9) days (−28% change [95% CI −45 to −11], P = 0.001) in the intervention arm but did not change in the control arm (1.8 [2.0] to 1.5 [1.8], −9% change [−25 to 6], P = 0.23). Early intervention reduced overt hyperglycemia (55% decrease in patient-days with mean glucose >15 mmol/L, P < 0.001) and hospital-acquired infections (odds ratio 0.20 [95% CI 0.07–0.58], P = 0.003). CONCLUSIONS Early identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

“…We chose 15 mmol/L because it pragmatically defined an unsafe hyperglycaemic extreme that should generally be avoided, regardless of clinical context, but does not require aggressive treatment that could increase the risk of hypoglycaemia. The impact of hospital diabetes care quality improvement programs can be assessed with the AGD concept; a recent cluster randomised trial found that AGD incidence, as a primary outcome measure, was reduced by an early intervention model of inpatient diabetes care …”

“…Glucometric assessment might be possible without networked meter technology, but it would require more resources, and incomplete or inaccurate data would be more likely. Most importantly, networked meters contribute to improved glycaemic and clinical outcomes by enabling remote surveillance of BG measurements and proactive glycaemic management programs …”

Inpatient Transition to Virtual Care During COVID-19 Pandemic

“…Some recent studies have suggested that improved glycemic control may reduce hospital-acquired infections and decrease length of stay, particularly when implemented in the context of a diabetes management service. 4 For these reasons, the ADA recommends specialized inpatient diabetes management services when possible. 3 Intensification of the coronavirus disease 2019 (COVID-19) outbreak caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to new challenges related to diabetes care in the hospital.…”

Identification of metabolomics biomarkers for type 2 diabetes: triangulating evidence from longitudinal and Mendelian randomization analyses

“…Early detection of individuals with high T2DM predisposition is important as non-pharmacological approaches (i.e. lifestyle changes) can reduce substantially (and at a reduced cost) the risk of developing T2DM [3]. Thus, the use of predictive biological tests or clinical scores enabling a more precise identification of individuals at risk is a pressing need so that preventive measures can be applied to limit the increase of T2DM prevalence world-wide.…”