In-patient diabetes care: the impact of diabetes outreach team on long-term glycaemic control.

Abstract

Our aim is to assess the impact of inpatient diabetes services on glycaemic control in patient with diabetes admitted to a secondary care hospital in UK. We performed a retrospective analysis of all diabetes mellitus (DM) in-patients who were seen by our Diabetes Outreach Team from June 2007 to December 2010. Those with an admission diagnosis of hypoglycaemia were excluded. Blood samples including HbA1c at the initial visit and subsequent outpatient follow-up at 3-6months were collected. Patients admitted with newly diagnosed diabetes were analysed separately. In total 2002 patient data were captured. 778 patients were eliminated initially because of failure to attend follow-up clinic, lack of follow-up HbA1c data, and because of planned discharge to the community. Complete blood samples were available for 1224 patients. Of this, 235 patients (19.2% of those with complete data) were analysed separately as their primary diagnosis was hypoglycaemia. In the remaining 989 patients, 31 (3.1%) new onset Type 1 DM patients and 91 (9.2%) new onset Type 2 patients were analysed separately. In patients with known DM (n=867) HbA1c improved from 75mmol/mol (9.0%±2.39) to 69mmol/mol (8.46%±2.0) (p<0.001). In the newly diagnosed Type 1 DM (n=31) patients HbA1c improved from 114mmol/mol (12.55%±2.27) to 58mmol/mol (7.43%±2.05) (p<0.001). In the newly diagnosed Type 2 DM (n=91) patients HbA1c improved from 93mmol/mol (10.70%±3.04) to 56mol/mol (7.29%±1.74) (p<0.001). In those who presented with hypoglycaemia (n=235) HbA1c changed from 58mmol/mol (7.48%±1.59) to 59mmol/mol (7.59%±1.57) (p=0.2). By providing a comprehensive care, structured education and appropriate intervention through our Diabetes Outreach Team, we have shown a significant reduction in HbA1c for recently hospitalised patients.