Background: In hospitalised patients, both hypoglycaemia and significant hyperglycaemia are associated with adverse outcomes. We hypothesised that a proactive inpatient diabetes service (IDS), which electronically identifies inpatients with diabetes and provides immediate management, will decrease the incidence of adverse glycaemia & hospital complications.
Methods: RAPIDS (ACTRN12616000265471) was a cluster-randomised trial on 8 wards of a tertiary hospital. Consecutive inpatients with diabetes or new-onset hyperglycaemia (random blood glucose [BG] ≥11.1 mmol/L without known diabetes) were recruited. Networked glucose meters recorded capillary BG measures from admission until discharge, or day 14 for long-stayers. There was a 10-week baseline observational phase followed by a 12-week active phase, where the wards were cluster-randomised into 4 intervention and 4 control wards. Intervention wards received proactive IDS (early consultation by endocrinologist or nurse practitioner without referral), while control wards continued usual care (a referral-based consultation service). Primary outcome was the incidence of adverse glycaemic days [AGD] (patient-day with any BG <4.0 or >15.0 mmol/L) and secondary outcomes were mean glucose, hospital-acquired infections and length of stay.
Results: We investigated 1002 patients (87% type 2 diabetes; 29% insulin-treated; HbA1c: 7.5±1.7%) totalling 5447 patient-days & 19062 BG measures. Incidence of AGD decreased in the intervention wards (243 vs. 186 per 1000 patient-days [23% decrease], p<0.001), but there was no change in the control wards. On multivariable analysis, proactive IDS was independently associated with 24% decrease in AGD (p=0.005). Proactive IDS decreased patient-day mean glucose (mean [SD]: 9.0 [2.7] vs. 9.5 [3.2] mmol/L, p<0.001), and the incidence of hospital-acquired infections (7% vs. 3%, p=0.02; adjusted OR: 0.24, 95% CI: 0.08-0.67, p=0.007). There was no difference in length of stay.
Conclusion: This randomised trial of a proactive diabetes service decreased the incidence of adverse glycaemia and hospital-acquired infections and may change the approach to inpatient diabetes care.