A team led by Mervyn Kyi from Royal Melbourne Hospital (VIC, Australia) investigated whether early electronic identification of patients with diabetes and bedside management within 24 hours of admission to hospital improved outcomes. Early identification of inpatients was associated with reduced overt hyperglycemia and hospital-acquired infections. The results have recently been published in an April issue of Diabetes Care.
The early intervention model included 1,002 adults with diabetes or new hyperglycemia on eight hospital wards. There was a 10-week baseline period where all clusters received usual care, followed by a 12-week period where clusters were randomized to early intervention or usual care. In the early intervention arm more patients received specialist diabetes management and new insulin treatment compared to the control arm, 92% vs. 15%, p < 0.001 and 57% vs. 34%, p = 0.001, respectively.
The incidence of adverse glycemic days decreased by 24% (p < 0.001) in patients assigned to the early intervention arm with no change in the control arm, at the cluster level. Furthermore, patients in the early intervention arm had reduced overt hyperglycemia with a 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).
"With the increasing prevalence of diabetes and complexity of hospital care, hospital clinicians should concentrate on early identification and management to improve the care of people with diabetes," the authors wrote.