None listed
Conditions
Brief summary
Background: The prevalence of diabetes in hospitalised patients is 25-30% in Australian hospitals. During hospitalisation for surgery or acute medical illness, diabetes management becomes more difficult. Resultantly, hypoglycaemia (low blood glucose) and hyperglycaemia (high blood glucose) frequently occur with associated complications including infections, longer length of stay and mortality. The management of inpatient diabetes remains suboptimal due to multiple factors, including altered physiology, dynamic hospital processes and medication changes. There is inattention and clinical inertia to inpatient diabetes management due to numerous pressures on hospital beds, expediting acute care and the increasing prevalence of diabetes. This study seeks to investigate a novel, proactive model of inpatient diabetes care. Methods: This study is a cluster-randomised controlled trial of a proactive Inpatient Diabetes Service (IDS) model of care. The IDS will identify inpatients with known diabetes and inpatients with new-onset hyperglycaemia using connectivity blood glucose meters and a "glucose alert pathway". The IDS will deliver a proactive consult service to these patients without referral from the treating teams, early in their admission. The IDS will manage inpatient diabetes care and facilitate discharge for these patients with the aim of increasing safety, reducing adverse glycaemia and reducing diabetes related complications. Consecutive inpatients with known diabetes or new-onset hyperglycaemia, admitted to the 8 participating wards will be included. The participating 8 wards will be cluster-randomised to 4 intervention and 4 control wards. The trial consists of a 3-months baseline period followed by a 3-months intervention period. It is hypothesised that the proactive IDS will reduce adverse glycaemia (unsafe blood glucose levels), adverse clinical outcomes and reduce length of stay in hospitalised patients with diabetes.
Interventions
A proactive inpatient diabetes service (IDS)
1) Consists of an endocrinology registrar & diabetes nurse practitioner, overseen by an endocrinologist. The IDS will also include diabetes nurse educators and a dietician.
2) Identifies inpatients with known diabetes or new hyperglycaemia without diabetes (fasting BGL > 7.0 mmol/L or random BGL > 11.1 mmol/L) using Connectivity Blood Glucose Meters (CBGM) and a central repository of point of care blood glucose levels (BGL).
3) Identifies inpatient
A proactive inpatient diabetes service (IDS) 1) Consists of an endocrinology registrar & diabetes nurse practitioner, overseen by an endocrinologist. The IDS will also include diabetes nurse educators and a dietician. 2) Identifies inpatients with known diabetes or new hyperglycaemia without diabetes (fasting BGL > 7.0 mmol/L or random BGL > 11.1 mmol/L) using Connectivity Blood Glucose Meters (CBGM) and a central repository of point of care blood glucose levels (BGL). 3) Identifies inpatients with unstable BGL or altered clinical state via the Glucose Alert Pathway. Glucose alert pathway is a paper-based clinical escalation guideline for nursing and treating team medical staff in response to hypoglycaemia, hyperglycaemia or a change in diabetes-related clinical status. 4) Delivers a consult service on all patients with known diabetes or new hyperglycaemia, early in their admission (aim within 48 hours after admission) & without referral from the treating team (proactive care). The consultation includes: a) Assessment of diabetes control prior to admission and during hospitalisation. b) Appropriate adjustment of diabetes-related medications and insulin during hospitalisation c) Provision of appropriate diabetes education and/or dietary advice d) Optimisation of diabetes therapy at discharge from hospital A typical consult may last 5 - 20 minutes depending on the clinical scenario. The IDS may provide a single or multiple consults depending on clinical status. (e.g. if regular insulin or diabetes medication dose titration is required, there may be daily or second-daily consults, until discharge). 5) Delivers individualised diabetes care in hospital using a variety of appropriate diabetes medication and insulin regimens depending on the clinical scenario. 6) Facilitate discharge by formulating diabetes regimen and follow up plans following discharge. These plans will be communicated to the patient's local medical officer by a discharge summary. The IDS intervention will be in place for 3 months.
Sponsors
Royal Melbourne Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Consecutive inpatients with 1) Known diabetes OR 2) New hyperglycaemia without known diabetes (fasting BGL > 7.0 mmol/L or random BGL > 11.1 mmol/L) that are admitted to the 8 participating wards at the Royal Melbourne Hospital.
Exclusion criteria
Patients admitted under the diabetes and endocrinology team as the treating team. Patients admitted under palliative care team
Outcome results
None listed