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Chertok Shacham E, Maman N, Ishay A. Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19 infection: A retrospective study. Medicine (Baltimore) 2023; 102:e32650. [PMID: 36701712 PMCID: PMC9857348 DOI: 10.1097/md.0000000000032650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.
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Affiliation(s)
- Elena Chertok Shacham
- Endocrinology Unit, Haemek Medical Center, Afula, Israel
- * Correspondence: Elena Chertok Shacham, Haemek Medical Center, Endocrinology Unit, Rabin Ave 21, Afula 18134, Israel (e-mail: )
| | - Nimra Maman
- Statistic Department, Haemek Medical Center, Afula, Israel
| | - Avraham Ishay
- Endocrinology Unit, Haemek Medical Center, Afula, Israel
- Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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Narindrarangkura P, Ye Q, Boren SA, Khan U, Simoes EJ, Kim MS. Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework. J Diabetes Sci Technol 2023; 17:152-162. [PMID: 34530644 PMCID: PMC9846388 DOI: 10.1177/19322968211043534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors® (ADCES7®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories. METHODS We searched apps using the search terms: "diabetes," "blood sugar," "glucose," and "mood" from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract. RESULTS We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension. CONCLUSIONS Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Qing Ye
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Suzanne A. Boren
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Uzma Khan
- Department of Medicine, Cosmopolitan
International Diabetes and Endocrinology Center, University of Missouri, Columbia,
MO, USA
| | - Eduardo J. Simoes
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Min Soon Kim
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
- Min Soon Kim, PhD, Department of Health
Management and Informatics, University of Missouri Institute for Data Science
and Informatics, University of Missouri, 5 Hospital Drive, Columbia, MO 65212,
USA.
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D'Amico RP, Pian TM, Buschur EO. Transition From Pediatric to Adult Care for Individuals With Type 1 Diabetes: Opportunities and Challenges. Endocr Pract 2022; 29:279-285. [PMID: 36528273 DOI: 10.1016/j.eprac.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Type 1 diabetes (T1D) is a chronic disease with patients across the age spectrum that has high potential for morbidity and mortality. Unfortunately, patients transitioning from pediatric to adult care continue to demonstrate worsened glycemic control in part due to lack of understanding of transition of care best practices. METHODS This review highlights the impact of existing transition of care interventions, assessment tools, and other recently published strategies for providers to consider to improve care of adolescent and young adult (AYA) patients with T1D in both hospital- and clinic-based settings. RESULTS Many barriers impact patients with T1D during the transition period and disparities by race, sex, insurance status, and comorbid illness persist. As diabetic care continues to evolve and the prevalence of adolescents and young adults living with T1D increases, an intentional approach to transition of care is more pressing than ever. While current literature on transition of care models is limited, many show promise in improving clinic attendance and decreasing hospitalization. There are critical discussions that providers should lead with AYA patients to improve their outcomes and increase diabetes self-management, such as re-addressing carbohydrate counseling, sleep hygiene, and reproductive planning. CONCLUSION While further research on transition of care is needed, many care models offer the promise of improved T1D outcomes, enhancements in our approach to care, and increased value for our health care system at large.
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Affiliation(s)
- Rachel P D'Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timothy M Pian
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth O Buschur
- Division of Endocrinology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
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White A, Buschur E, Harris C, Pennell ML, Soliman A, Wyne K, Dungan KM. Influence of Literacy, Self-Efficacy, and Social Support on Diabetes-Related Outcomes Following Hospital Discharge. Diabetes Metab Syndr Obes 2022; 15:2323-2334. [PMID: 35958875 PMCID: PMC9359168 DOI: 10.2147/dmso.s327158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D). Methods This is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days). Results A1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate -0.21, 95% CI -0.40, -0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days. Conclusion The study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions. Clinical Trial NCT03455985.
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Affiliation(s)
- Audrey White
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Elizabeth Buschur
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA
| | - Cara Harris
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, 43210, USA
| | - Adam Soliman
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA
| | - Kathleen Wyne
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA
| | - Kathleen M Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA
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5
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White A, Bradley D, Buschur E, Harris C, LaFleur J, Pennell M, Soliman A, Wyne K, Dungan K. Effectiveness of a Diabetes-Focused Electronic Discharge Order Set and Postdischarge Nursing Support Among Poorly Controlled Hospitalized Patients: Randomized Controlled Trial. JMIR Diabetes 2022; 7:e33401. [PMID: 35881437 PMCID: PMC9364166 DOI: 10.2196/33401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/10/2022] [Accepted: 06/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although the use of electronic order sets has become standard practice for inpatient diabetes management, there is limited decision support at discharge. OBJECTIVE In this study, we assessed whether an electronic discharge order set (DOS) plus nurse follow-up calls improve discharge orders and postdischarge outcomes among hospitalized patients with type 2 diabetes mellitus. METHODS This was a randomized, open-label, single center study that compared an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with type 2 diabetes mellitus. The primary outcome was change in glycated hemoglobin (HbA1c) level at 24 weeks after discharge. The secondary outcomes included the completeness and accuracy of discharge prescriptions related to diabetes. RESULTS This study was stopped early because of feasibility concerns related to the long-term follow-up. However, 158 participants were enrolled (DOS: n=82; ESC: n=76), of whom 155 had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (78% vs 44%; P=.01), needles or syringes (95% vs 63%; P=.03), and glucometers (86% vs 36%; P<.001). The clarity of the orders was similar. HbA1c data were available for 54 participants in each arm at 12 weeks and for 44 and 45 participants in the DOS and ESC arms, respectively, at 24 weeks. The unadjusted difference in change in HbA1c level (DOS - ESC) was -0.6% (SD 0.4%; P=.18) at 12 weeks and -1.1% (SD 0.4%; P=.01) at 24 weeks. The adjusted difference in change in HbA1c level was -0.5% (SD 0.4%; P=.20) at 12 weeks and -0.7% (SD 0.4%; P=.09) at 24 weeks. The achievement of the individualized HbA1c target was greater in the DOS group at 12 weeks but not at 24 weeks. CONCLUSIONS An intervention that included a DOS plus a postdischarge nurse phone call resulted in more complete discharge prescriptions. The assessment of postdischarge outcomes was limited, owing to the loss of the long-term follow-up, but it suggested a possible benefit in glucose control. TRIAL REGISTRATION ClinicalTrials.gov NCT03455985; https://clinicaltrials.gov/ct2/show/NCT03455985.
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Affiliation(s)
- Audrey White
- Internal Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Bradley
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States
| | - Elizabeth Buschur
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States
| | - Cara Harris
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States
| | - Jacob LaFleur
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Michael Pennell
- Division of Biostatistics, Department of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, United States
| | - Adam Soliman
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Kathleen Wyne
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States
| | - Kathleen Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States
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6
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Bah SM, Alibrahem AB, Alshawi AJ, Almuslim HH, Aldossary HA. Effects of routinely collected health information system variables on the readmission of patients with type 2 diabetes. J Taibah Univ Med Sci 2021; 16:894-899. [PMID: 34899135 PMCID: PMC8626805 DOI: 10.1016/j.jtumed.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This research explores the association between variables routinely collected in a health information system and the readmission of patients with type 2 diabetes within 30 days of discharge. METHODS This retrospective cohort study was conducted at King Fahd Hospital of the University (KFHU) in Al-Khobar, KSA. The study population comprised patients with type 2 diabetes who were admitted to the hospital from January 2016 to November 2016. Data were obtained from the hospital's information system at KFHU. The association between the readmission of patients with type 2 diabetes and routinely collected health information system variables such as demographics, type of diabetes, length of stay, and discharge type were analyzed. RESULTS A total of 497 cases met the inclusion criteria. Of these, 31 (6.2%) cases were readmitted within 30 days. Type 2 diabetes was the only variable found to be significantly associated with readmission within 30 days (χ2 (1, N = 497) = 6.116, p = 0.0134). Diabetes type (p = 0.0133) and discharge type (p = 0.0403) were the only variables that displayed significance utilizing a logistic regression model. CONCLUSION Overall, the routinely collected demographic, diagnostic, and administrative variables were found to be poor predictors of 30-day readmission for type 2 diabetes at the institution studied. Nonetheless, the only significant variables in the prediction of 30-day readmission were diabetes type and discharge type. To determine the predictors of readmission, it is recommended that future studies include height and weight to the routinely collected health information system variables. We also suggest that future studies be based on data collected over several years or on pooled data collected from several hospitals.
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Affiliation(s)
- Sulaiman M. Bah
- Public Health Department, College of Public Health, Imam Abdulrahman Bin Faisal University, KSA
| | - Anwar B. Alibrahem
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, KSA
| | - Ayat J. Alshawi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, KSA
| | - Hameeda H. Almuslim
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, KSA
| | - Hessa A. Aldossary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, KSA
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Chakraborty A, Pearson O, Schwartzkopff KM, O'rourke I, Ranasinghe I, Mah PM, Adams R, Boyd M, Wittert G. The effectiveness of in-hospital interventions on reducing hospital length of stay and readmission of patients with Type 2 Diabetes Mellitus: A systematic review. Diabetes Res Clin Pract 2021; 174:108363. [PMID: 32771487 DOI: 10.1016/j.diabres.2020.108363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 01/04/2023]
Abstract
AIM This review aimed to assess the effectiveness of multifaceted in-hospital interventions for patients with type 2 diabetes mellitus on hospital readmission, hospital length of stay (LOS), and glycated haemoglobin (HbA1c). METHODS The search included MEDLINE, EMBASE, Emcare, Web of Science, PsycINFO and Google Scholar from 2007 to current date and restricted to English. The differences in outcome measures were calculated to determine the effectiveness. RESULTS The title and abstract of 3251 records were initially screened. Nine studies met the inclusion criteria. Most studies comprised of a wide range of intervention components and outcome measures. The reduction in hospital LOS ranged from 0.5 to 0.8 of a day. Clinically significant improvements in HbA1c concentration levels ranged from a mean reduction of -1.1 (±2.2) mmol/L to -2.8 (±2.7) mmol/L. There were no significant changes in hospital readmission rates and no evidence of the impact of HbA1c on hospital LOS and readmission. Common strategies in reducing hospital LOS and HbA1c were a dedicated care team, hospital wide approach, quality improvement focus, insulin therapy, early short-term intensive program, transition to primary care physicians, and on-going outpatient follow-up for at least 6-12 months. CONCLUSIONS The findings illustrate that multifaceted in-hospital intervention for patients diagnosed with type 2 diabetes can contribute to improvements in hospital LOS and HbA1c concentration.
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Affiliation(s)
- Amal Chakraborty
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Research Centre for Palliative Care, Death and Dying, Flinders University, Bedford Park, SA 5042.
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Kate M Schwartzkopff
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Iris O'rourke
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Isuru Ranasinghe
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Peak Mann Mah
- Northern Adelaide Local Health Network (NALHN), SA Health, SA 5000, Australia
| | - Robert Adams
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Mark Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Gary Wittert
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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Shacham EC, Nitzan R, Schwartz N, Ishay A. Effects of Recommendations for Diabetes Management at Hospital Discharge on Long-Term Diabetes Control. Endocr Pract 2021; 27:118-123. [PMID: 33616045 DOI: 10.1016/j.eprac.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the impact of diabetes-specific recommendations at 1 year after hospital discharge on glycemic control and diabetes care in an outpatient setting. METHODS A total of 139 patients with type 2 diabetes on a basal-bolus insulin regimen during hospitalization were included in the statistical analysis. We gathered data on treatment regimens after 12 to 16, 26 to 30, and 52 to 56 weeks following discharge as well as glycosylated hemoglobin (HbA1c) levels for all patients. Prescriptions for diabetes therapy were retrieved. All changes in insulin or oral/noninsulin injectable drug regimens were recorded. RESULTS Half of the patients (n = 69) were discharged on their preadmission regimen (no change), and a change in the home treatment was recommended in the other half (n = 70). In the group of patients whose preadmission therapy was adjusted, HbA1c decreased from 9.6% (80 mmol/mol) to 8.5% (69 mmol/mol) (P = .0004) 1 year after discharge. In the group of patients discharged on their preadmission regimen, no significant changes in HbA1c levels during the study were observed. At follow-ups occurring 12 to 16 weeks after discharge, 52% (95% CI: 37.4%-66.3%) of patients in the change group had their treatment modified, compared with 18.6% (95% CI: 9.7%-30.9%) in the no-change group. In the group of patients discharged on their preadmission regimen, no significant change was observed. At the beginning of the study, patients in the change treatment group had higher HbA1c levels than patients in the no-change group (9.6 ± 2.0 vs 8.6 ± 1.7, P < .001). At the end of the study, no significant changes in terms of HbA1c levels were found between the groups (8.8 ± 1.9 vs 8.5 ± 1.9, P = .2). CONCLUSIONS Significant improvement in diabetes control occurred 1 year after hospital discharge in patients who underwent modifications in their treatment. This supports the relevance of providing and implementing proper care recommendations at transition.
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Affiliation(s)
- Elena Chertok Shacham
- Endocrinology Unit; Internal Medicine Department E, Haemek Medical Center, Afula, Israel.
| | | | - Naama Schwartz
- Statistics Department, Carmel Medical Center, Haifa, Israel
| | - Avraham Ishay
- Endocrinology Unit; Technion - Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Foucault-Fruchard L, Bizzoto L, Allemang-Trivalle A, Renoult-Pierre P, Antier D. Compared benefits of educational programs dedicated to diabetic patients with or without community pharmacist involvement. Prim Health Care Res Dev 2020; 21:e49. [PMID: 33155539 PMCID: PMC7681120 DOI: 10.1017/s1463423620000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist. AIM To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups. METHODS A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m2 at M0) of patients in Control (n = 20), TEP-H (n = 20) and DIAB-CH (n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test. FINDINGS While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 (P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group (P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups (P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 (P = 0.0044). No significant difference (P > 0.05) in BMI between the groups was observed. CONCLUSION The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.
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Affiliation(s)
- Laura Foucault-Fruchard
- Pharmacy Department, Tours University Hospital, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Laura Bizzoto
- Pharmacy Department, Tours University Hospital, Tours, France
- Faculty of Pharmacy, University of Tours, Tours, France
| | | | | | - Daniel Antier
- Pharmacy Department, Tours University Hospital, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Powers A, Winder M, Maurer M, Brittain K. Impact of inpatient diabetes transitions of care consult on glycemic control. PATIENT EDUCATION AND COUNSELING 2020; 103:1255-1257. [PMID: 32014273 DOI: 10.1016/j.pec.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE(S) An evaluation of a diabetes consult service for hospitalized patients was completed to determine effect on glycemic control. METHODS This medical record review was conducted to determine impact of a short-term program on patients with diabetes. The electronic medical record was used to identify patients diagnosed with diabetes mellitus and hospitalized from September 2016 to September 2017. A case-control design was utilized to compare patients with an inpatient order for the diabetes transitions of care service to those receiving usual care. The consultation service consisted of inpatient diabetes education and follow-up post discharge. The HbA1c reduction of adult inpatients those who completed a consult (n = 67) and those who received usual care (n = 67) were compared. Statistical analyses were conducted. RESULTS For the primary outcome of HbA1c reduction at 3 months, absolute difference from baseline to 3 months in the intervention was -2.9 % compared to 0.9 % in the control group (p < 0.001). CONCLUSIONS Participation in the service reduced HbA1c at 3 months and 6 months post-discharge, reduced 30-day all-cause readmissions, and increased percentage of patients with HbA1c <9.0 % at 6 months post-discharge. PRACTICAL IMPLICATIONS A consult-based diabetes transitions of care service decreased HbA1c versus usual care.
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Affiliation(s)
- Ashleigh Powers
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
| | - Marquita Winder
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States.
| | - MaryAnne Maurer
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
| | - Kevin Brittain
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
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Montero AR, Dubin JS, Sack P, Magee MF. Future technology-enabled care for diabetes and hyperglycemia in the hospital setting. World J Diabetes 2019; 10:473-480. [PMID: 31558981 PMCID: PMC6748879 DOI: 10.4239/wjd.v10.i9.473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 02/05/2023] Open
Abstract
Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging. Inpatient technology-enabled support systems are being designed, adapted and evaluated to meet this challenge. Insulin pump use, increasingly common in outpatients, has been shown to be safe among select inpatients. Dedicated pump protocols and provider training are needed to optimize pump use in the hospital. Continuous glucose monitoring (CGM) has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit (ICU) settings but data on cost effectiveness is lacking. CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns. Compared to unstructured insulin prescription, a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems. Relative efficacy and cost among these systems remains unanswered. An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital. These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.
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Affiliation(s)
- Alex Renato Montero
- MedStar Diabetes Institute, Washington, DC 20010, United States
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Jeffrey S Dubin
- MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Paul Sack
- MedStar Diabetes Institute, Washington, DC 20010, United States
- MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
| | - Michelle F Magee
- MedStar Diabetes Institute, Washington, DC 20010, United States
- MedStar Health Research Institute, Washington, DC 20010, United States
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12
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Nassar CM, Montero A, Magee MF. Inpatient Diabetes Education in the Real World: an Overview of Guidelines and Delivery Models. Curr Diab Rep 2019; 19:103. [PMID: 31515653 DOI: 10.1007/s11892-019-1222-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Diabetes self-management education and support improves diabetes-related outcomes, yet less than 50% of persons with diabetes in the USA receive this service. Hospital admissions present a critical opportunity for providing diabetes education. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. RECENT FINDINGS As diabetes rates continue to soar and adults with diabetes continue to have high hospitalization and readmission rates, hospitals face challenges in assessing and meeting diabetes patients' educational needs. The consensus recommendation for inpatient diabetes teaching is to provide survival skills education to enable safe self-management following discharge until more comprehensive outpatient education can be provided. Established and emerging models for delivery of diabetes survival skills education in the hospital may be broadly grouped as diabetes-specialty care models, diabetes non-specialty care models, and technology-supported diabetes education. These models are often shaped by the availability of diabetes specialists, including endocrinologists and diabetes educators-or lack thereof, and staffing resources for provision of services. Recent studies suggest that all three approaches can be deployed successfully if well planned. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. The authors seek to make the reader aware of the heterogeneous approaches that are being implemented nationwide for inpatient diabetes education delivery. Meeting inpatient diabetes educational needs will require a sustained effort, diverse strategies based on resources available, and additional research to explore the impact of these strategies on outcomes.
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Affiliation(s)
- Carine M Nassar
- MedStar Health Research Institute, Hyattsville, MD, USA.
- MedStar Diabetes Institute, Washington, DC, USA.
| | - Alex Montero
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Michelle F Magee
- MedStar Health Research Institute, Hyattsville, MD, USA
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
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13
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Lysy Z, Fung K, Giannakeas V, Fischer HD, Bell CM, Lipscombe LL. The Association Between Insulin Initiation and Adverse Outcomes After Hospital Discharge in Older Adults: a Population-Based Cohort Study. J Gen Intern Med 2019; 34:575-582. [PMID: 30756304 PMCID: PMC6445910 DOI: 10.1007/s11606-019-04849-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/10/2018] [Accepted: 12/27/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Starting insulin therapy in hospitalized patients may be associated with an increase in serious adverse events after discharge. OBJECTIVE Determine whether post-discharge risks of death and rehospitalization are higher for older hospitalized patients prescribed new insulin therapy compared with oral hypoglycemic agents (OHAs). DESIGN Retrospective population-based cohort study including hospital admissions in Ontario, Canada, between April 1, 2004, and Nov 30, 2013. PATIENTS Persons aged 66 and over discharged after a hospitalization and dispensed a prescription for insulin and/or an OHA within 7 days of discharge. We included 104,525 individuals, subcategorized into four mutually exclusive exposure groups based on anti-hyperglycemic drug use in the 7 days post-discharge and the 365 days prior to the index admission. MAIN MEASURES Prescriptions at discharge were categorized as new insulin (no insulin before admission), prevalent insulin (prescribed insulin before admission), new OHA(s) (no OHA or insulin before admission), and prevalent OHA (prescribed OHA only before admission) as the referent category. The primary and secondary outcomes were 30-day deaths and emergency department (ED) visits or readmissions respectively. KEY RESULTS Of 104,525 patients, 9.2% were initiated on insulin, 4.1% died, and 26.2% had an ED visit or readmission within 30 days of discharge. Deaths occurred in 7.14% of new insulin users, 4.86% of prevalent insulin users, 3.25% of new OHA users, and 3.45% of prevalent OHA users. After adjustment for covariates, new insulin users had a significantly higher risk of death (adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.46 to 1.74) and ED visit/readmissions (aHR 1.17, 95% CI 1.12 to 1.22) than prevalent OHA users. CONCLUSIONS Initiation of insulin therapy in older hospitalized patients is associated with a higher risk of death and ED visits/readmissions after discharge, highlighting a need for better transitional care of insulin-treated patients.
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Affiliation(s)
- Zoe Lysy
- Women's College Hospital, Women's College Research Institute, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Vasily Giannakeas
- Women's College Hospital, Women's College Research Institute, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Sinai Health System, Toronto, Canada
| | - Lorraine L Lipscombe
- Women's College Hospital, Women's College Research Institute, 76 Grenville St, Toronto, ON, M5S 1B2, Canada. .,Department of Medicine, University of Toronto, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Murphy JA, Schroeder MN, Ridner AT, Gregory ME, Whitner JB, Hackett SG. Impact of a Pharmacy-Initiated Inpatient Diabetes Patient Education Program on 30-Day Readmission Rates. J Pharm Pract 2019; 33:754-759. [DOI: 10.1177/0897190019833217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: In October 2012, a pharmacy-driven Inpatient Diabetes Patient Education (IDPE) program was implemented at the University of Toledo Medical Center (UTMC). Objective: To determine the difference in 30-day hospital readmission rates for patients who receive IDPE compared to those who do not. Methods: This retrospective cohort was completed at UTMC. Patients admitted between October 1, 2012, and September 30, 2013, were included if they were ≥18 years and had one of the following: (1) diagnosis of diabetes mellitus, (2) blood glucose >200 mg/dL (>11.11 mmol/L) on admission, or (3) hemoglobin A1C of >6.5% (>48 mmol/mol). Patients who received IDPE from a pharmacist or student pharmacist (intervention group) were compared to patients who did not receive IDPE (control group). Results: The 30-day readmission rate was 13.2% for the intervention group (n = 364) and 21.5% for the control group (n = 149) ( P = .023). Average time to 30-day readmission was 13.1 (±8.3) days for the IDPE group and 11.9 (±7.9) days for the control group. There was no significant difference in diabetes-related readmission between the intervention and control groups (25.5% vs 21.9%). Conclusions: An IDPE program delivered primarily by pharmacists and student pharmacists significantly reduced 30-day readmission rates among patients with diabetes.
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Affiliation(s)
- Julie A. Murphy
- Department of Pharmacy Practice, University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Michelle N. Schroeder
- Department of Pharmacy Practice, University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Anita T. Ridner
- Department of Pharmacy, The University of Toledo Medical Center, Toledo, OH, USA
| | - Megan E. Gregory
- Department of Pharmacy, Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | - Sean G. Hackett
- Department of Pharmacy, Cleveland Clinic Euclid Hospital, Euclid, OH, USA
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Gianchandani RY, Pasquel FJ, Rubin DJ, Dungan KM, Vellanki P, Wang H, Anzola I, Gomez P, Hodish I, Lathkar-Pradhan S, Iyengar J, Umpierrez GE. THE EFFICACY AND SAFETY OF CO-ADMINISTRATION OF SITAGLIPTIN WITH METFORMIN IN PATIENTS WITH TYPE 2 DIABETES AT HOSPITAL DISCHARGE. Endocr Pract 2018; 24:556-564. [PMID: 29949432 DOI: 10.4158/ep-2018-0036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Few randomized controlled trials have focused on the optimal management of patients with type 2 diabetes (T2D) during the transition from the inpatient to outpatient setting. This multicenter open-label study explored a discharge strategy based on admission hemoglobin A1c (HbA1c) to guide therapy in general medicine and surgery patients with T2D. METHODS Patients with HbA1c ≤7% (53 mmol/mol) were discharged on sitagliptin and metformin; patients with HbA1c between 7 and 9% (53-75 mmol/mol) and those >9% (75 mmol/mol) were discharged on sitagliptinmetformin with glargine U-100 at 50% or 80% of the hospital daily dose. The primary outcome was change in HbA1c at 3 and 6 months after discharge. RESULTS Mean HbA1c on admission for the entire cohort (N = 253) was 8.70 ± 2.3% and decreased to 7.30 ± 1.5% and 7.30 ± 1.7% at 3 and 6 months ( P<.001). Patients with HbA1c <7% went from 6.3 ± 0.5% to 6.3 ± 0.80% and 6.2 ± 1.0% at 3 and 6 months. Patients with HbA1c between 7 and 9% had a reduction from 8.0 ± 0.6% to 7.3 ± 1.1% and 7.3 ± 1.3%, and those with HbA1c >9% from 11.3 ± 1.7% to 8.0 ± 1.8% and 8.0 ± 2.0% at 3 and 6 months after discharge (both P<.001). Clinically significant hypoglycemia (<54 mg/dL) was observed in 4%, 4%, and 7% among patients with a HbA1c <7%, 7 to 9%, and >9%, while a glucose <40 mg/dL was reported in <1% in all groups. CONCLUSION The proposed HbA1c-based hospital discharge algorithm using a combination of sitagliptin-metformin was safe and significantly improved glycemic control after hospital discharge in general medicine and surgery patients with T2D. ABBREVIATIONS BG = blood glucose; DPP-4 = dipeptidyl peptidase-4; eGFR = estimated glomerular filtration rate; HbA1c = hemoglobin A1c; T2D = type 2 diabetes.
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Gregory NS, Seley JJ, Dargar SK, Galla N, Gerber LM, Lee JI. Strategies to Prevent Readmission in High-Risk Patients with Diabetes: the Importance of an Interdisciplinary Approach. Curr Diab Rep 2018; 18:54. [PMID: 29931547 DOI: 10.1007/s11892-018-1027-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Patients with diabetes are known to have higher 30-day readmission rates compared to the general inpatient population. A number of strategies have been shown to be effective in lowering readmission rates. RECENT FINDINGS A review of the current literature revealed several strategies that have been associated with a decreased risk of readmission in high-risk patients with diabetes. These strategies include inpatient diabetes survival skills education and medication reconciliation prior to discharge to send the patient home with the "right" medications. Other key strategies include scheduling a follow-up phone call soon after discharge and an office visit to adjust the diabetes regimen. The authors identified the most successful strategies to reduce readmissions as well as some institutional barriers to following a transitional care program. Recent studies have identified risk factors in the diabetes population that are associated with an increased risk of readmission as well as interventions to lower this risk. A standardized transitional care program that focuses on providing interventions while reducing barriers to implementation can contribute to a decreased risk of readmission.
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Affiliation(s)
- Naina Sinha Gregory
- Department of Medicine, Division of Endocrinology, Weill Cornell Medicine, 211 East 80th Street, New York, NY, 10075, USA.
| | - Jane J Seley
- Division of Nursing, NewYork-Presbyterian Hospital, New York, NY, USA
- Weill Cornell Medicine, 413 East 69 Street, Box 55 Baker Bldg., Room F2025, New York, NY, 10021, USA
| | - Savira Kochhar Dargar
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 1330 York Avenue, Baker F2020, New York, NY, 10065, USA
| | - Naveen Galla
- Weill Cornell Medical College, 420 East 70th Street, Apt 7N1, New York, NY, 10021, USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA
| | - Jennifer I Lee
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 1330 York Avenue, Baker F2020, New York, NY, 10065, USA
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Abstract
This article was originally published with errors that were introduced during the editing process. The corrected version of this article appears below.
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Affiliation(s)
- Daniel J Rubin
- Section of Endocrinology, Diabetes, and Metabolism, School of Medicine, Temple University, 3322 N. Broad ST., Ste 205, Philadelphia, PA, 19140, USA.
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Garg R, Hurwitz S, Rein R, Schuman B, Underwood P, Bhandari S. Effect of follow-up by a hospital diabetes care team on diabetes control at one year after discharge from the hospital. Diabetes Res Clin Pract 2017; 133:78-84. [PMID: 28898714 DOI: 10.1016/j.diabres.2017.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022]
Abstract
AIM This study was conducted to evaluate the effect of continued follow-up by a hospital diabetes team on HbA1c at 1-year after discharge. METHODS Adults with HbA1c ≥8% (64mmol/mol), undergoing an elective surgery, were treated in the perioperative period and randomized to continued care (CC) or the usual care (UC) after discharge. Patients in the CC group received weekly to monthly phone calls from a diabetes specialist nurse practitioner (NP) to review their home blood glucose values, diet, exercise, and medications. Patients in the UC group followed with their diabetes care providers. RESULTS Out of 151 patients, 77 were randomized to the CC group and 74 to the UC group. HbA1c (%) at 1-year was 8.2±1.4 in the CC group and 8.5±1.5 in the UC group (p=NS). Change in HbA1c from baseline was similar between the groups; -0.7±1.4 in the CC versus -0.7±1.5 in the UC group (p=NS). A higher number of calls was not associated with lower HbA1c or reduction in HbA1c. There were 41 insulin-treated patients in the CC group and 53 in the UC group and among them, HbA1c reduction was 0.5±1.5 and 0.6±1.3 respectively (p=NS). CONCLUSIONS Optimal perioperative treatment of diabetes is associated with an improvement in HbA1c but continued follow-up by a hospital diabetes team after discharge does not have an additional impact on long-term glycemic control. ClinicalTrials.gov identifier NCT02065050.
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Affiliation(s)
- Rajesh Garg
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Shelley Hurwitz
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Raquel Rein
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Brooke Schuman
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Patricia Underwood
- Veterans Health Administration, 150 South Huntington Avenue, Boston, MA 02130, United States
| | - Shreya Bhandari
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide practical evidence-based recommendations for transitioning hospitalized patients with type 2 diabetes (T2DM) to home. RECENT FINDINGS Hospitalized patients who have newly diagnosed or poorly controlled T2DM require initiation or intensification of their outpatient diabetes regimen. Potential barriers to medication access and continuity of care should be identified early in the hospitalization. Throughout hospitalization, patients should receive diabetes education focused on basic survival skills and tailored to learning needs. Patients should leave the hospital with personalized discharge instructions that include a list of all medications and follow-up appointments with both the outpatient diabetes provider and a diabetes educator whenever possible. An approach to transitioning patients with T2DM from hospital to home that focuses on optimizing the patient's discharge diabetes regimen, anticipating patients' needs during the immediate post-discharge period, providing survival skills education, and ensuring continuation of diabetes care and education following hospital discharge has the potential to improve glycemic control and reduce emergency department visits and hospital readmissions.
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Affiliation(s)
- Amy C Donihi
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy & University of Pittsburgh Medical Center (UPMC), MUH NE Suite 628, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Golden SH, Maruthur N, Mathioudakis N, Spanakis E, Rubin D, Zilbermint M, Hill-Briggs F. The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes. Curr Diab Rep 2017; 17:51. [PMID: 28567711 PMCID: PMC5553206 DOI: 10.1007/s11892-017-0875-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. RECENT FINDINGS Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.
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Affiliation(s)
- Sherita Hill Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA.
- Departments of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nisa Maruthur
- Departments of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA
| | - Elias Spanakis
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland Medical System, Baltimore, MD, USA
| | - Daniel Rubin
- Division of Endocrinology and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Mihail Zilbermint
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Felicia Hill-Briggs
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Ramos P, MacIndoe J. A Blueprint for Improving Systemwide Inpatient Glucose Management. Jt Comm J Qual Patient Saf 2017; 43:176-178. [DOI: 10.1016/j.jcjq.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brumm S, Theisen K, Falciglia M. Diabetes Transition Care From an Inpatient to Outpatient Setting in a Veteran Population: Quality Improvement Pilot Study. DIABETES EDUCATOR 2016; 42:346-53. [PMID: 27052977 DOI: 10.1177/0145721716642020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of the study was to evaluate a diabetes transition care program in a population of veterans with diabetes by calculating 30-day readmission rates and assessing glycemic control. METHODS Hospitalized patients with poorly controlled diabetes were identified to participate in the diabetes transition care program. The program included follow-up through a postdischarge telephone call by the diabetes educator, with an opportunity for a face-to-face clinic visit. A retrospective before-and-after study design was used. Analysis included calculating the readmission rate and the pre- and postintervention A1C rates to evaluate the intervention. RESULTS Of the 40 participants, 100% completed the intervention. All 40 participants received a postdischarge telephone call as follow-up, with 20% presenting for a face-to-face visit. The 30-day readmission rate for the cohort was 10%, in comparison to 14.3% for patients who did not receive the intervention but were otherwise comparable. For those who had repeat A1C measurements conducted 2 to 8 months after time of enrollment in the program (n = 33), average A1C declined -2.2%, from 11.3% (100 mmol/mol) to 9.1% (76 mmol/mol). CONCLUSIONS Diabetes-specific transition of care for those with complex psychiatric, medical, and social needs was feasible, with good outcomes in hospital readmission rates and glycemic control, when executed by an adult nurse practitioner who was the inpatient diabetes educator.
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Affiliation(s)
- Susan Brumm
- Cincinnati Veteran Affairs Medical Center, Cincinnati, Ohio, USA (Ms Brumm, Dr Falciglia)
| | - Kathleen Theisen
- Xavier University School of Nursing, Cincinnati, OH, USA (Ms Theisen)
| | - Mercedes Falciglia
- Cincinnati Veteran Affairs Medical Center, Cincinnati, Ohio, USA (Ms Brumm, Dr Falciglia),University of Cincinnati College of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Cincinnati, Ohio, USA (Dr Falciglia)
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Lutzko OK, Schifferle H, Ariola M, Rich A, Kon KM. Optimizing insulin initiation in primary care: the Diabetes CoStars patient support program. Pragmat Obs Res 2016; 7:3-10. [PMID: 27799841 PMCID: PMC5085308 DOI: 10.2147/por.s94456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the optimization of fasting blood glucose (FBG) levels in patients with type 2 diabetes mellitus newly initiated on insulin glargine who were enrolled in the Australian Diabetes CoStars Patient Support Program (PSP). PATIENTS AND METHODS A retrospective analysis of data from 514 patients with type 2 diabetes mellitus who completed the 12-week Diabetes CoStars PSP was performed. All patients were initiated on insulin glargine in primary care and enrolled by their general practitioner, who selected a predefined titration plan and support from a local Credentialled Diabetes Educator. The data collected included initial and final insulin dose, self-reported FBG, and glycated hemoglobin (A1c) levels. RESULTS The insulin dose increased in 81% of patients. Mean FBG was reduced from 208.8 mg/dL (11.6 mmol/L) to 136.8 mg/dL (7.6 mmol/L) after 12 weeks. Initial and final A1c values were available for 99 patients; mean A1c was reduced from 9.5% (80 mmol/mol) to 8.1% (65 mmol/mol). The reductions in mean FBG and A1c were similar irrespective of titration plan. Overall, 27.2% of patients achieved FBG levels within the titration plan target range of 72-108 mg/dL (4-6 mmol/L) and an additional 43.4% of patients achieved FBG within the range recommended by current Australian guidelines (110-144 mg/dL [6.1-8.0 mmol/L]). Overall, 23.3% of patients achieved the A1c target of ≤7%. CONCLUSION These data demonstrate that the majority of patients enrolled in the Diabetes CoStars PSP achieved acceptable FBG levels 12 weeks after starting insulin therapy irrespective of titration plan.
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Affiliation(s)
| | | | - Marita Ariola
- Innerwest Specialist Centre, Burwood, NSW, Australia
| | | | - Khen Meng Kon
- Sanofi Australia Pty Ltd, Macquarie Park, NSW, Australia
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Ji L, Zhang P, Weng J, Lu J, Guo X, Jia W, Yang W, Zou D, Zhou Z, Pan C, Gao Y, Li X, Zhu D, Li Y, Wu Y, Garg SK. Observational Registry of Basal Insulin Treatment (ORBIT) in Patients with Type 2 Diabetes Uncontrolled by Oral Hypoglycemic Agents in China--Study Design and Baseline Characteristics. Diabetes Technol Ther 2015; 17:735-44. [PMID: 26171728 DOI: 10.1089/dia.2015.0054] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Efficacy of basal insulin (BI) has been well studied by randomized controlled trials, but the impact of BI on glycemic control in the real world has not been well documented. The Observational Registry for BI Treatment (ORBIT) study is designed to evaluate the real-life outcomes of BI in China. MATERIALS AND METHODS Participants with type 2 diabetes (n=19,894), from December 2011 to June 2013, inadequately controlled on oral hypoglycemic agents (OHAs) were initiated on BI treatment from 209 hospitals in all the eight regions in Mainland China. Data for each patient on use of OHAs and insulin (type and dose), glycemic control, hypoglycemic episodes, body weight, quality of life, and costs were collected at baseline and 3 and 6 months. RESULTS For the 18,995 participants who were eligible for baseline analysis, mean±SD age was 55.4±10.4 years, with 52.5% males. The mean duration of diabetes was 6.4±5.3 years and was positively associated with the economic level of eight regions. Before initiation of BI, patients had a mean hemoglobin A1c level of 9.6±2.0% with a fasting plasma glucose level of 11.7±4.0 mmol/L. Of the patients, 35.5% had some diabetes complications. Metformin, sulfonylureas, and α-glycosidase inhibitors were the most commonly used OHAs. The proportions of patients using one, two, or more than two OHAs before BI initiation were 48.4%, 42.7%, and 8.9%, respectively. CONCLUSIONS To the best of our knowledge, the ORBIT study is the largest registry study to evaluate glycemic outcomes and safety of BI in real-world China. Baseline data indicate delays in initiation of BI in the majority of patients with type 2 diabetes in China.
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Affiliation(s)
- Linong Ji
- 1 Peking University People's Hospital , Beijing, China
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Puhong Zhang
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Jianping Weng
- 3 The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, China
| | - Juming Lu
- 4 Chinese PLA General Hospital , Beijing, China
| | - Xiaohui Guo
- 1 Peking University People's Hospital , Beijing, China
| | | | - Wenying Yang
- 6 China-Japan Friendship Hospital , Beijing, China
| | - Dajin Zou
- 7 The Second Military Medical University , Shanghai, China
| | | | - Changyu Pan
- 9 Beijing 301 Military General Hospital , Beijing, China
| | - Yan Gao
- 1 Peking University People's Hospital , Beijing, China
| | - Xian Li
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Dongshan Zhu
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Ying Li
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Yangfeng Wu
- 2 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Satish K Garg
- 10 Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
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Abstract
Hospital readmission is a high-priority health care quality measure and target for cost reduction. Despite broad interest in readmission, relatively little research has focused on patients with diabetes. The burden of diabetes among hospitalized patients, however, is substantial, growing, and costly, and readmissions contribute a significant portion of this burden. Reducing readmission rates of diabetic patients has the potential to greatly reduce health care costs while simultaneously improving care. Risk factors for readmission in this population include lower socioeconomic status, racial/ethnic minority, comorbidity burden, public insurance, emergent or urgent admission, and a history of recent prior hospitalization. Hospitalized patients with diabetes may be at higher risk of readmission than those without diabetes. Potential ways to reduce readmission risk are inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support. More studies are needed to test the effect of these interventions on the readmission rates of patients with diabetes.
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Affiliation(s)
- Daniel J Rubin
- Section of Endocrinology, Diabetes, and Metabolism, School of Medicine, Temple University, 3322 N. Broad ST., Ste 205, Philadelphia, PA, 19140, USA.
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Kanikkannan S, Sukul V. The Role of Laboratory Evaluation in the Management of Hospital-Based DM: “When Did HbA1C Become an Inpatient Test?”. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40138-015-0066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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