658-P: Regular Diabetes Ward Round Is Associated with Better Infection Control and Lower Mortality Rate in Inpatients Younger than 80 Years Old

Abstract

Background: While good glycemic control during hospitalization has been reported to have better outcomes and reduced complications, achieving this is difficult in hospitals where diabetes specialists are not present or understaffed. Diabetes ward round by an independent and specialized team (DMWR) is one of the solutions for regular monitoring of glycemic control in inpatients, few studies existed to assess its effectiveness. Material and Methods: A team composed of two diabetes specialists, one specialized nurse, one dietician, one pharmacist, and one assistant conducted DMWR from May 2017. Hospital inpatients who were at risk of poorly controlled glycemia were given adequate advice to prevent hyperglycemia and hypoglycemia. A total of 384,422 capillary blood glucose measurements were taken from all hospitalized patients from April 2015 to March 2019 and the changes in frequency of hyperglycemic and hypoglycemic episodes were analyzed. Infection control was evaluated by episodes of blood cultures. The mortality rate at discharge and within 90 days of discharge were also calculated. Results: The odds ratio (OR) for the frequency of pre-prandial hyperglycemia before and after DMWR was 0.430 (95% confidence interval (CI): 0.407, 0.454). The OR for that of severe hypoglycemia was 0.371 (95% CI: 0.265, 0.520). The number of blood cultures was significantly reduced by 26% after DMWR. The mortality rate within 90 days of discharge was also significantly decreased in patients aged less than 65 (OR 0.363, 95%CI: 0.216, 0.609) and from 65 to 79 (OR 0.689, 95%CI: 0.541, 0.856), respectively. Conclusion: DMWR resulted in improved glycemic control and reduced staff burden for managing severe hypoglycemia and preventable infection events. Moreover, the mortality rate of patients less than 80 years of age was also reduced over the same period, suggesting that stabilizing blood sugar was beneficial for lowering mortality rate in the younger patient population. Disclosure S. Chou: None. M. Haraguchi: None. M. Imai: None. M. Ishibashi: None. M. Masano: None. Y. Iwata: None. Y. Oda: None. T. Motogami: None. S. Nakamura: None.