Hospital-based integrated diabetes care management: an overview

How Do Hospitals Organize Diabetes Services? A Comparative Study

Most patients with diabetes will present to hospital for a reason not directly related to their diabetes. When a person with diabetes is not cared for properly, hospitalization can become complicated and lead to worse consequences for the patient. In fact, it is important to know how to manage a diabetic patient while in hospital. Therefore, a special organization is needed in hospitals for adaptation to chronic diseases such as diabetes. This study intends to help hospital adaptation to the special needs of diabetic patients by identifying patterns of care delivery in selected countries. This comparative study was performed in 2021. The data collection was conducted by searching in PubMed, Web of Knowledge, Scopus, Science Direct, Springer, Proquest, and also the websites of the selected countries hospitals. Based on the sampling method, three countries, Turkey, United Kingdom, and the United States, were selected from the countries with eligibility. However, during the study, according to the good practices about special diabetic care of countries such as Australia and Denmark, they were also examined. In this review study, we organized and compared the effective measures taken in selected countries in relation to the management of these patients in the hospital, focusing on the dimensions of service package, human resource, process, structure, equipment/technology, and information system required by diabetic patients.

Chronic care model in the diabetes pay-for-performance program in Taiwan: Benefits, challenges and future directions

In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.

Self-monitoring of blood glucose in association with glycemic control in newly diagnosed non-insulin-treated diabetes patients: a retrospective cohort study

The benefits of self-monitoring of blood glucose (SMBG) on glycemic control among type 2 diabetes (T2DM) patients not receiving insulin remains controversial. This study aimed to examine the association between SMBG and glycemic control in these patients. This retrospective longitudinal study enrolled 4987 eligible patients from a medical center in Taiwan. Data were collected from electronic medical records at 0 (baseline), 3, 6, 9, and 12 (end-point) months after enrollment. Patients were assigned to the early SMBG group or to the non-user group depending on whether they performed SMBG at baseline. Differences in glycated hemoglobin (HbA1c) reduction between groups at each time-point were assessed using SMBG group-by-time interaction in generalized estimating equations models, which were established using backward elimination method for multivariate regression analysis. Subgroup analyses for patients using non-insulin and insulin secretagogues were performed additionally. The estimated maximal difference in HbA1c reduction between groups (early SMBG users vs. non-users) was 0.55% at 3 months. Subgroup analyses showed maximal differences of 0.61% and 0.52% at 3 months in the non-insulin and insulin secretagogues groups, respectively. SMBG group-by-time interaction was statistically significant at 3 months and lasted for 12 months. The finding suggests that performing SMBG at disease onset was positively associated with better glycemic control in newly diagnosed non-insulin-treated T2DM patients, regardless whether non-insulin secretagogues or insulin secretagogues were used.