Early intervention model of inpatient diabetes care improves glycemia following hospitalization

Abstract

Admission to hospital provides an opportunity to optimize long-term diabetes management, but clinical inertia is common. We previously reported the randomized study of a proactive inpatient diabetes service (RAPIDS), investigating an early intervention model of care and demonstrated improved in-hospital glycemia and clinical outcomes. This follow-up study assessed whether proactive care in hospital improved postdischarge HbA1c. In a subgroup of 298 RAPIDS trial participants with type 2 diabetes, age <80 years, and admission HbA1c ≥ 7.0%, diabetes treatment intensification occurred more often in early intervention versus usual care groups (37% vs. 19% [p =.001]), adjusted odds ratio 3.2 (95% confidence interval [CI]: 1.7–6.0). There was a greater change in HbA1c in the early intervention group (mean −0.9% [95% CI −1.3 to −0.4]) versus the usual care group (−0.3% [−0.6 to −0.1]), p =.029. The value of acute care by dedicated inpatient diabetes teams can extend beyond improving inpatient clinical outcomes and can lead to sustained improvement in glycemia.