Please select the eligibility criteria that correspond to the clinical trial below.
Title: Comprehensive Intervention to Evaluate Outcomes AND Cost in Hospitalized Surgical Patients With DM: COACH-DM
Brief Summary: This study is being performed to evaluate whether a comprehensive discharge planning and close follow up for one year can improve clinical outcomes and cut costs of care for patients with poorly controlled diabetes. The study takes a high risk approach and is focused on patients admitted to hospital for elective surgery with HbA1c \>8%. Secondary goals include improving teamwork and communication for clinicians within the team and teaching nurse practitioners and physicians-in-training how to work effectively within interdisciplinary teams. Investigators anticipate that the results of this project may lead to the following benefits: 1) improved health outcomes for surgical patients with diabetes, 2) improved strategies for better communication within interdisciplinary health care teams, and 3) decreased health care costs.


Options:
A: Inclusion Criteria:

* Veterans with type 2 diabetes managed for \> 1 year at an eligible site (Durham, Raleigh, Greenville, or Morehead City) will be eligible for enrollment.
* We will identify Veterans with PPDM (defined as the presence of at least 2 A1c values of \> 9.0% during the past year with no readings of \< 9.0% despite ongoing medical care) by reviewing electronic medical records and soliciting referrals from primary physicians.

Exclusion Criteria:

* Exclusion criteria will include lack of telephone access or severe hearing/ speech impairment that would limit:

  * telephone interaction
  * metastatic cancer
  * active psychosis documented in medical record
  * active alcohol or substance abuse
  * diagnosis of dementia
  * known pregnancy (patients becoming pregnant during the study will be withdrawn and referred to appropriate services)
  * documented seizure history
  * documented history of severe complications of hypoglycemia (such as coma or seizure)
  * documented refusal or inability to perform self-monitoring of blood glucose
  * ongoing use of warfarin with prior history of major bleeding event
* Due to challenges with dose adjustment by phone, Veterans on continuous subcutaneous insulin infusion (insulin pumps) will not be eligible for this study.

  * Due to challenges with regulations regarding testing supplies pts will need to be taking insulin (a few patients had enrolled prior to this change.).
B: Inclusion Criteria:

* Age 70 years and older
* Diagnosis of type 1 or type 2 diabetes
* Seen at Joslin Clinic or Beth Israel Deaconess Medical Center for at least one year
* HbA1c 8% X 2 in past 6 months without fluctuation of more than 0.5% (i.e. stable poor control)
* No major change in medications in past 3 months, e.g. addition of insulin or another hypoglycemic agent

Exclusion Criteria:

* Patients with terminal diseases, e.g. malignancy with expected life expectancy of 12 months or less
* Patients who live more than 25 miles from Joslin Clinic/Beth Israel Deaconess Medical Center
* Patients who live in an institutional setting (e.g. nursing home, group home, etc)
* Patients who are not able to complete outcome assessments, (e.g. poor vision, diminished mental capacity/severe cognitive decline, unable to speak/read/write English
C: Inclusion Criteria:

* elective surgery
* HbA1c \>=8% within 3 months before surgery
* Age \> 18 years

Exclusion Criteria:

* undergoing same day surgery without post-operative admission
* HbA1c \< 8%
* individuals undergoing bariatric surgery
* individuals with metastatic cancer or short life expectancy
D: Inclusion Criteria:

* Diagnosis of type 2 diabetes (medication and HbA1c\>7% and no cardiovascular disease), coronary artery disease (history of myocardial infarction or revascularisation) or heart failure (NYHA II-III and admitted in a hospital for the condition within 2 years)
* Aged 45 years or older
* Resident in the Päijät-Häme health care district

Exclusion Criteria:

* Classified as ineligible by primary care physician
* Unable to co-operate or participate in health coaching
* Major elective surgery planned within 6 months
* History of major surgery within past 2 years
* Life expectancy \<1 year
* Pregnancy

Answer: C