None listed
Conditions
Brief summary
The objective of the research is to examine the difference in blood glucose control and length of stay in people that manage their own insulin and blood sugar levels in hospital versus people whose insulin and blood glucose cares are performed by a clinician (usual care) in an acute care setting. Blood glucose control will be measured by a continuous glucose monitor that will measure the percentage of time the blood glucose is within range. Participants will be screened for participation in the study and will require informed consent. Eligibility is people over the age of 18 who have been managing their insulin independently at home prior to admission. Participants will be randomly allocated to either the intervention or control group. The intervention group will measure their blood glucose levels via finger prick and inject their own insulin as they do at home. The control group will be managed by the nurses and doctors as is current practice. Continuous Glucose Monitoring will be performed on all participants. Out study will investigate if independent patient diabetes management in the acute setting will lead to improved glucose control, reduced length of stay, improved patient satisfaction, improved clinician satisfaction and reduced readmissions within 30 days.
Interventions
The intervention will involve the diabetic in-patient measuring their own blood glucose levels, determining their own dose of insulin, and administering their insulin dose.
Trial information will be communicated to patients in the Patient Information and Consent Form delivered for this trial.
Patients will initially be assessed using a screening tool designed for this trial. This tool will ascertain if the patient has skills and knowledge necessary for self-administration of insulin and self-m
The intervention will involve the diabetic in-patient measuring their own blood glucose levels, determining their own dose of insulin, and administering their insulin dose. Trial information will be communicated to patients in the Patient Information and Consent Form delivered for this trial. Patients will initially be assessed using a screening tool designed for this trial. This tool will ascertain if the patient has skills and knowledge necessary for self-administration of insulin and self-monitoring of blood glucose levels. Clinicians will be assessed on competencies required for monitoring and delivering diabetes care information. If clinicians do not meet the required competencies, additional training will be provided by the Endocrinologist and diabetes educator. Trial participants in the self-management group will be required to take their own blood glucose measurements and administer their own insulin. A written insulin patient information resource has been developed specifically for this study and will be provided to patients for information on these skills. Patients will only be eligible for the trial if they can independently demonstrate self-management. This will be supervised by nurses on the ward and the doctors of the treating medical team. Procedures to be undertaken by patients in the self-management group: - Blood glucose measurement - the patient will prick their finger with a lancet, and will measure the resulting blood sample by putting it on the test strip and inserting into the blood glucose monitor. The result will be recorded in the patient's self-report diary. The record will then be transcribed by the patient's nurse into the electronic medical record. Blood glucose measurement will be undertaken up to 6 times per day as required. - Insulin dosage administration - the patient will adjust the insulin dosage based on glucose level and food intake as required, and will draw up the correct dose and administer using the injector pen device. The patient's nurse will then record in the electronic medical record the dose that has been delivered. These processes will be undertaken for the duration of the in-patient admission until discharge. Insulin administration will be undertaken up to 3 times per day at meal times as required. Procedures undertaken by all participants: - Continuous glucose monitoring - this small wearable device is attached to the skin to measure glucose levels at all times of the day or night. Participants will wear this device for 14 days, and will not see the glucose readings.
Sponsors
Mackay Hospital and Health Service
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients who have been self-managing their insulin prior to admission discharge.
Exclusion criteria
• People who will not be self-managing their insulin on discharge • People who are confused and not orientated to time and place • People who lack mental capacity and have inability to provide informed consent • People admitted with Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycaemic State (HHS) requiring an insulin infusion • People whose clinical condition deteriorates e.g. becomes confused, more unwell, or dependent on nursing cares • Physical disabilities that prevents self-administration
Outcome results
None listed