Hyperglycaemia in inpatients with type 2 diabetes may necessitate initiation of injectable diabetes therapies during hospitalization to improve glycaemic control. Adapting to this intensification of therapy can be difficult for inpatients, and diabetes education performed in the hospital setting is subject to a number of factors which may limit its effectiveness. Home-based diabetes education is emerging as a tool that may facilitate effective diabetes education in patients commencing injectable diabetes therapies.
A pilot feasibility randomised-controlled trial was conducted to determine whether diabetes care, comprising in-home diabetes education by a credentialed diabetes educator (CDE) and early post-discharge assessment by an endocrinologist, would safely enable transition from hospital to home on injectable diabetes therapies.
Inpatients commencing injectable diabetes therapies were randomised to receive in-home diabetes education within 48 hours following discharge, or usual care. The intervention group had endocrinologist follow-up within 4 weeks and at 16 weeks post-randomization. The primary outcome was safety (hospital admission, emergency department presentation), and secondary outcomes were HbA1c, patient satisfaction with care (measured by DTSQ) and length of hospital stay.
103 inpatients were randomized to in-home diabetes education or usual care. After 16 weeks of follow-up, hospital presentations and readmissions did not differ between groups. There was one diabetes-related hospital presentation following discharge in each group. Preliminary statistical analysis found no difference in patient satisfaction or ΔHbA1c between groups.
For patients commencing injectable therapies, the results of this pilot feasibility RCT suggest that the use of a transitions diabetes team, comprising CDE for in-home diabetes education and endocrinologist follow-up is a safe and acceptable model of care.