Diabetes mellitus: a diabetic team intervention reduced readmissions

Clinical bottom line (level 1b)

  1. In-patients with diabetes who received care from a diabetic intervention team compared with usual care were less likely to be readmitted (NNT = 6 at 3 months) .
Koproski et al: Diabetes Care 1997; 20 (10): 1553-1555
Expires October 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, USA

179 patients (aged 15 to 94, 50% female) diabetes mellitus

Excluded if
  • primary care physician refused to participate
  • discharged with 72 hours of admission or against medical advice
  • previously enrolled in study


    • Control Group: (n = 94, 94 analysed): usual care
    Experimental Group: (n = 85, 85 analysed): diabetic team intervention: endocrinologist support to primary care physician, with nutrition and social intervention as required

    100% followed for 6 months
    Outcome notes:
    • good blood glucose levels : capillary levels between 4.4 mmol/l and 9.9 mmol/l

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    good blood glucose levels 4 weeks 43
    (45.7%)    		 64
    (75.3%)    		 65%
    (28% to 112%)    		 29.6%
    (15.9% to 43.2%)    		 3
    (2 to 6)
    readmission to hospital 3 months 30
    (31.9%)    		 13
    (15.3%)    		 52%
    (14% to 73%)    		 16.6%
    (4.48% to 28.8%)    		 6
    (3 to 22)

    Comments

    1. Patients in the intervention group were more likely to have documented instructions on blood glucose monitoring and for insulin administration. Patients were more likely to receive documented education and nutritional consultation.
    2. Practically, the most important outcomes were a tendency for a reduction in hospitalization length and a significant decrease in readmissions for at least six months after discharge. These findings suggest that team intervention could be both important in improving patient health and cost effectiveness of hospitalized diabetic patients.
    3. These findings need to be replicated in larger trials, and expanded to examine various diabetic populations of varying ethnic and socioeconomic backgrounds.

    Citation

    1. Koproski J, Pretto Z, Poretsky L: effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes Care 1997; 20 (10): 1553-1555
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer: Jon Levine

    Clinical Question.
    Patient DKA
    Intervention or Exposure specialised multidisciplinary team
    Outcome blood sugar control, readmission rates