Early intervention for diabetes in medical and surgical inpatients decreases hyperglycemia and hospital-acquired infections : A cluster randomized trial
Kyi, Mervyn, Colman, Peter G., Wraight, Paul R., Reid, Jane, Gorelik, A., Gorelik, Alexandra, GalligaKumar, Shanaln, Anna, Rowan, Lois M., Marley, Katie A., Nankervis, Alison J., Russell, David M. and Fourlanos, Spiros. (2019). Early intervention for diabetes in medical and surgical inpatients decreases hyperglycemia and hospital-acquired infections : A cluster randomized trial. Diabetes Care. 45(5), pp. 832-840. https://doi.org/10.2337/dc18-2342
|Authors||Kyi, Mervyn, Colman, Peter G., Wraight, Paul R., Reid, Jane, Gorelik, A., Gorelik, Alexandra, GalligaKumar, Shanaln, Anna, Rowan, Lois M., Marley, Katie A., Nankervis, Alison J., Russell, David M. and Fourlanos, Spiros|
OBJECTIVE To investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care.
RESEARCH DESIGN AND METHODS We investigated a proactive or early intervention model of care (whereby an inpatient diabetes team electronically identified individuals with diabetes and aimed to provide bedside management within 24 h of admission) compared with usual care (a referral-based consultation service). We conducted a cluster randomized trial on eight wards, consisting of a 10-week baseline period (all clusters received usual care) followed by a 12-week active period (clusters randomized to early intervention or usual care). Outcomes were adverse glycemic days (AGDs) (patient-days with glucose <4 or >15 mmol/L [<72 or >270 mg/dL]) and adverse patient outcomes.
RESULTS We included 1,002 consecutive adult inpatients with diabetes or new hyperglycemia. More patients received specialist diabetes management (92% vs. 15%, P < 0.001) and new insulin treatment (57% vs. 34%, P = 0.001) with early intervention. At the cluster level, incidence of AGDs decreased by 24% from 243 to 186 per 1,000 patient-days in the intervention arm (P < 0.001), with no change in the control arm. At the individual level, adjusted number of AGDs per person decreased from a mean 1.4 (SD 1.6) to 1.0 (0.9) days (−28% change [95% CI −45 to −11], P = 0.001) in the intervention arm but did not change in the control arm (1.8 [2.0] to 1.5 [1.8], −9% change [−25 to 6], P = 0.23). Early intervention reduced overt hyperglycemia (55% decrease in patient-days with mean glucose >15 mmol/L, P < 0.001) and hospital-acquired infections (odds ratio 0.20 [95% CI 0.07–0.58], P = 0.003).
CONCLUSIONS Early identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.
|Journal citation||45 (5), pp. 832-840|
|Publisher||American Diabetes Association|
|Digital Object Identifier (DOI)||https://doi.org/10.2337/dc18-2342|
|Funder||National Health and Medical Research Council|
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File Access Level
|Online||28 Mar 2019|
|Publication process dates|
|Accepted||01 Feb 2019|
|Deposited||02 Jun 2021|
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