We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Early Intervention for Diabetes in Medical and Surgical Inpatients Decreases Hyperglycemia and Hospital-Acquired Infections: A Cluster Randomized Trial.
- Authors
Kyi, Mervyn; Colman, Peter G.; Wraight, Paul R.; Reid, Jane; Gorelik, Alexandra; Galligan, Anna; Kumar, Shanal; Rowan, Lois M.; Marley, Katie A.; Nankervis, Alison J.; Russell, David M.; Fourlanos, Spiros
- Abstract
<bold>Objective: </bold>To investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care.<bold>Research Design and Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>Early identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.
- Subjects
CLUSTER randomized controlled trials; EARLY medical intervention; NOSOCOMIAL infections; HYPERGLYCEMIA; GLYCEMIC control; TREATMENT of diabetes; HYPERGLYCEMIA prevention; HYPERGLYCEMIA treatment; CROSS infection prevention; BLOOD sugar; CLUSTER analysis (Statistics); COMPARATIVE studies; CROSS infection; DIABETES; HOSPITAL care; HOSPITAL patients; HOSPITAL wards; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research
- Publication
Diabetes Care, 2019, Vol 42, Issue 5, p832
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc18-2342