Improving the transition of care for inpatients with Type 2 Diabetes. — ASN Events
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  3. Improving the transition of care for inpatients with Type 2 Diabetes.

Improving the transition of care for inpatients with Type 2 Diabetes. (#347)

Felicity Pyrlis 1 , Rajna Ogrin 2 , Sonja Arthur 3 , Sara Baqar 1 , Victoria Stevenson 1 , Michele Mack 1 , Jeffrey D Zajac 1 3 , Elif I Ekinci 1 3
  1. Austin Health, Heidelberg, VIC, Australia
  2. Royal District Nursing Service, Melbourne, Victoria, Australia
  3. University of Melbourne, Melbourne, Victoria, Australia

Background:

Hyperglycaemia in inpatients with Type 2 Diabetes often necessitates initiation of injectable diabetes therapies in hospital to improve glycaemic control.  Self-management of these therapies is required before patients are considered safe for discharge, which may increase length of stay and health costs.

Aims:

A pilot randomised-controlled trial was conducted to determine whether diabetes care, comprising in-home diabetes education by a credentialed diabetes educator (CDE) and early post-discharge assessment by an endocrinologist, would safely and acceptably enable transition from hospital to home on injectable diabetes therapies, whilst reducing hospital length of stay (LOS).

Methods:

Inpatients commencing injectable diabetes therapies were randomised to receive in-home diabetes education 24-48 hours following discharge, or usual care.  Intervention group patients had endocrinologist follow-up within 4 weeks and at 16 weeks post-randomization.  Hba1c was assessed at baseline and 16 weeks.  All patients completed Diabetes Treatment Satisfaction Questionnaires (DTSQ) at randomization and 16 weeks.  Data on adverse events, including rates of hospital readmissions and emergency department presentations, were collected.

Results:

58 inpatients were randomized to in-home diabetes education or usual care.  Length of stay was 3 days lower in the intervention versus the control group (Median LOS (IQR) 8(6-13) vs 5(2-8) p=0.03).  Change in Hba1c did not differ between groups (Δ in Hba1c (±SD) -2.5% (2.2) intervention vs -3.1% (2.8) control p=0.6).Hospital presentations and readmissions did not differ between groups.  There was no difference in patient satisfaction between groups as measured by DTSQ (p=0.7). 

Conclusion:

For patients commencing injectable therapies, the results of this pilot RCT suggest that the use of a transitions diabetes team, comprising CDE for in-home diabetes education and endocrine follow-up, significantly reduces hospital length of stay and is acceptable to patients without compromising glycaemic control or readmission rates.