Inpatient management by a diabetes team associated with improved readmissions, reduced cost

The retrospective study at a single tertiary care referral medical center compared cost-effectiveness of care from a specialized diabetes team with care from a primary service team.

Inpatient management by a specialized diabetes team reduced 30-day readmission rates and inpatient costs, as well as improving care transitions and adherence to follow-up, a recent study found.

Researchers performed a retrospective study at a single tertiary referral medical center in Boston to compare the cost-effectiveness of two models of diabetes care in the hospital. In the first model, care of patients with diabetes was managed by a specialized diabetes team, including an endocrinologist, with or without housestaff or an endocrinology fellow; a diabetes nurse practitioner, a certified diabetes nurse education, and discharge/transition coordinators. In the second model, care was managed by a primary service team, defined as hospitalists, general internal/family medicine, or general surgery physicians with or without housestaff.

Patients with diabetes who had been admitted to noncritical care units over six months were matched 1:1 according to the mean of their initial four blood glucose values after admission. The study's primary outcomes were 30-day readmission rate and frequency, length of stay, and estimated hospital cost, while secondary outcomes were glycemic control, variability in blood glucose levels, and hypoglycemia and hyperglycemia. Results were published online April 5 by BMJ Open Diabetes Research & Care.

Two hundred sixty-two patients were included in the study, 131 in each care model. Patients cared for by the primary service team were 55% male and had a mean age of 69.1 years, while patients cared for by the diabetes team were 58% male and had a mean age of 59.1 years. Patients with type 1 diabetes made up 34% of the patients cared for by the diabetes team versus only 4.6% of the primary service team patients (P<0.001). Complexity of diabetes and rates of in-hospital complications were significantly higher in patients treated by the diabetes team than in those treated by the primary service team.

The diabetes team group had a 30.5% lower rate of 30-day readmission to medical services versus the primary service team group (22.5% vs. 32.4%, respectively; P<0.001) but a 5% higher rate of 30-day readmission to surgical services (26.7% vs. 21.7%; P<0.05). Frequency of 30-day readmissions on the surgical services was lower in the diabetes team group (1.1 times per patient vs. 1.6 times; P=0.015). The two groups did not differ in length of stay for medical services, but the diabetes team group had a significantly longer length of stay for surgical services (5.6 days vs. 4.8 days; P<0.05). Patients who were seen by the diabetes team in the first 24 hours of admission had a significantly shorter length of stay versus those who were seen later (4.7 vs. 6.1 days; P<0.001).

The researchers noted that their study was retrospective in nature and involved only one facility and a relatively small number of patients. In addition, they pointed out that the study was not designed to evaluate patients with new diagnoses of diabetes and that readmissions to other hospitals may have been missed. However, they said their results suggest that management by a specialized diabetes team may benefit patients with diabetes who are hospitalized in noncritical medical units.

“Consultations of [specialized diabetes team] should be initiated early after admission and preferably within the first 24 hours of admission in order to reduce [length of stay],” the authors wrote. “Transition of [diabetes mellitus] care after discharge to [primary care physicians] and/or endocrinologists should be encouraged for all patients with [diabetes mellitus] discharged from either medical or surgical units to improve follow-up adherence and reduce 30-day readmission rate.”