Inpatient Multidisciplinary Proactive Assessment for Comprehensive Treatment of Diabetes (IMPACT D) on Glycaemia and Glycaemic Complications in Inpatients with Diabetes

The endocrinology consult service, diabetes educator and diabetes dietician will proactively instigate a bedside consult within 24 hours of randomisation (of inpatients with a single glucose reading above > 20mmol/L in the last 24 hours and/or two glucose readings > 15mmol/L in the preceding 24 hours). Endocrinology consults will involve discussions with patients regarding their current glycaemic management and strategies to improve their control, individualised for each patient. This may include education on what diabetes is and the rationale for good glycaemic control to prevent complications. Discussions regarding management will cover non-pharmacological and pharmacological options, how they work, and potential adverse effects to allow the patient to make an informed decision regarding changes or additions to therapy. such as the addition of insulin. The endocrinology consult service will also determine which patients should be reviewed by the diabetes nurse educators (DNE) and dieticians. DNEs will provide education tailored to the patient's current understanding. This may include education on different types of diabetes, how to monitor BGLs, manage hypoglycaemia, and injection technique for subcutaneous injections such as insulin. Dieticians will provide education on health diet and recommendations for the patient, particularly upon discharge. Frequency and duration of reviews will be determined by endocrinologist's clinical judgement based on patient glycaemic response. The duration of the first consult will likely range from 45-60 minutes. Subsequent reviews during the inpatient admission are expected to be shorter as they will involve review of BGLs and titration of medications such as insulin. The total duration of the intervention for each patient will be the duration of the inpatient period, or until the endocrinology consult service has made a clinical determination that there has been adequate improvement in glycaemic control prior to discharge. Electronic medical records will be reviewed to determine whether recommendations from the endocrinology consult service have been adhered to.