Increased Hyperglycemia and Hospital-Acquired Infections Following Withdrawal of the RAPIDS Early Intervention Model of Diabetes Care in Medical and Surgical Inpatients.

Abstract

Hyperglycemia is associated with hospital-acquired infection (HAI) and mortality, and treating hyperglycemia can improve outcomes in noncritical care (1,2). We previously reported the cluster Randomized Study of a Proactive Inpatient Diabetes Service (RAPIDS), where an early intervention model of diabetes care was investigated in medical and surgical inpatients (3). A proactive specialist diabetes team performed electronic glycemic surveillance and provided early bedside management for all inpatients with diabetes or hyperglycemia and demonstrated a 55% reduction in severe hyperglycemia (patient-days with mean blood glucose [BG] >270 mg/dL) and a 62% reduction in HAI. At the conclusion of RAPIDS, the proactive model of care was ceased due to lack of ongoing funding for this health care initiative. We performed this RAPIDS-extension observational study to evaluate glycemic and clinical outcomes after cessation of early intervention care, hypothesizing that hyperglycemia and HAI incidence would deteriorate back to baseline levels. RAPIDS included patients of eight medical and surgical wards at the tertiary Royal Melbourne Hospital, who were randomized to control or intervention arms. RAPIDS comprised a 10-week baseline period, where patients in all wards received usual care (diabetes management mostly performed by treating teams), followed by a 12-week active period, when patients in the intervention wards received proactive care (by an …