Effect of Inpatient Diabetes Management on Outpatient Glycemic Control

Study Overview
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Brief Summary
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The hypothesis of this study is that using hospital admission to identify patients with poorly controlled diabetes (hemoglobin A1c levels >8%), and intervening during the hospitalization with targeted inpatient diabetes management will improve glycemic control at 3 and 12 months, with inpatient glycemic control, quality of life, and diabetes self-efficacy serving as secondary endpoints.

Detailed Description
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The study is a randomized, controlled trial of targeted inpatient diabetes management versus usual care in 70 general medical and surgical inpatients over age 18 with type 2 diabetes and hemoglobin A1c levels greater than 8% who are followed in Partners-affiliated primary care practices. In addition, we will enroll a prospective chart review cohort matched for age, sex, and HbA1c level whose course we will follow for one year after discharge to determine the patter of glycemia among patients who are not enrolled in a clinical trial.

Official Title
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Effect of Inpatient Diabetes Management on Outpatient Glycemic Control

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Other: Diabetes management team


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years Known diagnosis of type 2 diabetes by history with outpatient prescription of oral hypoglycemic medication or insulin Hemoglobin A1c > 8.0% within the prior 12 months, or if not known, fasting blood glucose greater than 200 mg/dl on sliding scale regular insulin. Partners-affiliated primary care physician Exclusion Criteria: Screening HbA1c returns less than 8%. Diabetic ketoacidosis (DKA) as a primary reason for admission (admission blood glucose > 250 mg/dl with arterial pH < 7.30 or serum bicarbonate level < 15 mg/dl), or development of DKA during admission. Hyperosmolar hyperglycemic syndrome as a primary reason for admission (admission blood glucose > 400 mg/dl and plasma osmolality > 315 mOsm/kg. Pregnancy, ruled out by urine HCG test at screening after consent is obtained in all women who continue to have menstrual cycles. Anemia with hemoglobin < 9 g/dl, recent blood transfusion, or need for blood transfusion (interferes with interpretation of hemoglobin A1c assay) End stage liver disease with prothrombin time > 15 seconds and albumin <3 mg/dl End stage renal disease: Stage IV (glomerular filtration rate <30 mg/dl) or V chronic kidney disease Treatment with corticosteroids ICU transfer Inability to self-administer insulin Hypoglycemia unawareness: patient lacks sensation of common signs of blood glucose < 60 mg/dl (tachycardia, diaphoresis, hunger, confusion, fatigue). Projected survival < 1 year

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Diabetes Management Team<br>Evaluation and management by diabetes management team | Other: Diabetes management team<br>* MD evaluation followed by NP education and and medication titration<br>|
| No Intervention: Control<br>Patients receive usual care for diabetes | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemoglobin A1c | Change in glycemic control measured by HbA1c change baseline to 6 months | 6 months from discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average Intervention Effect Over 12 Months After Hospital Discharge |  | 12 months from discharge |