Impact of an Inpatient Diabetes Consulting Service on Post Discharge Glycemic Control

Abstract

"Diabetes mellitus has been estimated to affect 30 million Americans in 2015 with an increasing prevalence every year 1. In addition, patients with diabetes have up to a 3-fold increased risk of hospitalization 2. The health care cost for a person with diabetes has been calculated to be 2.3 times higher than that of a person without diabetes 3. The need for better systems of care has been increasingly recognized 4. Inpatient diabetes consultation results in improved glycemic control 5, shorter hospital stay 6 and decreased hospital readmission 7. Despite this, Wei et al 8 have previously shown that glycemic control does not improve post hospitalization and suggested it was a missed opportunity to implement better strategies for long term glycemic control. The Diabetes Consulting Service (DCS) in the inpatient setting at the Mayo Clinic frequently assists in the management of diabetic patients. The consultation addresses preadmission glycemic control, frequency of hypoglycemia at home, inpatient glycemic control, and discharge planning. Discharge planning involves incorporating glycemic control requirements during the hospital stay, prescribing discharge diabetes medications, and scheduling follow-up visits focused on post-discharge glycemic control. We hypothesized that the DCS would lead to improvement in glycemic control as measured by a reduction in HbA1c and a lower frequency of hypoglycemic events post discharge within a one-year period. Our primary aim was to determine if HbA1c was lower in patients receiving a DCS evaluation on post discharge. The secondary aim was to determine if there was a lower rate of self-reported hypoglycemia after discharge in patients receiving a DCS evaluation."--Introduction.