BOSTON – (May 15, 2018) – A retrospective study published in BMJ Open Diabetes Research & Care suggests that a program developed by Joslin Diabetes Center to manage hospitalized patients who have diabetes not only improves clinical outcomes, but also significantly reduces hospital costs. 

Roughly one third of patients admitted to the hospital have diabetes, and in the ICU, it’s even higher, probably 40 to 50 percent, says study coauthor Osama Hamdy, MD, PhD, FACE, Medical Director of Obesity Clinical Program and Inpatient Diabetes Program at Joslin Diabetes Center. “To reduce cost, most hospitals use primary service doctors or hospitalists to manage diabetes during patient stays. The under-recognized fact is that patients with diabetes have the longest hospital stays, and highest mortality, readmissions and in-hospital complications.”
For the study, the researchers sought to examine if inpatient diabetes management by a specialized diabetes team improves cost and outcomes better than management from a primary services team. 

Researchers examined patient records from 262 adults with diabetes admitted to a tertiary medical center in Boston between July 2012 and January 2013. One group of 131 patients received care from a primary services team, while another group of 131 patients received care from a specialized diabetes care team from Joslin Diabetes Center. 

The Joslin care model includes a group of specially-trained physicians, nurse practitioners, certified diabetes educators and discharge planners (plus an outpatient transition pathway) that work in tandem to ensure that each patient receives optimum diabetes care during hospitalization and after discharge. 

The researchers found that the benefits of inpatient diabetes-managed team care are considerable. People who received diabetes team care while hospitalized had a 30 percent lower readmission rate to non-critical medical services, compared to their counterparts who received standard care by a primary services team or hospitalists. 

Transition of care and adherence to post-discharge follow-up was much better in the diabetes team care group. “Compliance to the hospital discharge plan is usually very low, but in our study it was high for those who received specialty care, basic education during hospitalization and a specific diabetes discharge plan,” says Dr. Hamdy. 

The study further found that the hospital length of stay was one day shorter for patients in the diabetes care group when the diabetes care team was involved from the first day of admission. “People are in the most acute situation upon admission -- for example, their blood sugar is high and they may have infection, which can be prolonged, activated or complicated at that point,” says Dr. Hamdy. They need to be appropriately evaluated and treated right away. 
The study also demonstrated that there is significant financial benefit from using a specialized diabetes team to manage in-hospital care. The researchers estimated that use of diabetes team care for all patients with diabetes in non-critical care units of that medical center would save $3.5 million for one year.

“Around 43 percent of the total annual diabetes healthcare cost in the US, which is currently $327 billion, is related to inpatient diabetes care, therefore if we are going to reduce the overall costs of diabetes, doing something for people with diabetes in the hospital is a very important step to take,” says study coauthor Robert A. Gabbay, MD, PhD, Chief Medical Officer and Senior Vice President at Joslin Diabetes Center. 

 “My belief is that many hospitals are short-sighted. And they should start to work harder in managing patients with diabetes,” says Dr. Hamdy. “The diabetes team care model provides an efficient way to care for the diabetes patient from the first day of hospitalization all the way through to transition of care when the patient goes home.”

Other study authors include Vivek Bansal, Adham Mottalib, Taranveer K. Pawar, Noormuhammad Abbasakoor, Eunice Chuang, Abrar Chaudhry and Mahmoud Sakr.

Citation: Inpatient Diabetes Management by Specialized Diabetes Team Versus Primary Service Team in Non-Critical Care Units: Impact on 30-Day Readmission Rate and Hospital Cost. BMJ Open Diab Res Care 2018.