Diabetes is similar to other chronic medical conditions in the sense that it is associated with an increased risk of hospital readmissions. Studies have shown that 20% of patients with diabetes have had rehospitalizations within 30 days, with 30% of these patients being rehospitalized more than once in a year. These rehospitalizations occur more often among minority groups, those with a lower income, and those without private insurance. There is limited data to suggest that the involvement of a diabetes specialist team may reduce readmissions. Outpatient diabetes education by nurses has resulted in improved A1c levels and medication adherence, so researchers wanted to find out whether diabetes education during hospitalization could lower readmission rates in patients with poorly controlled diabetes.
A retrospective study was done on patients whose records were pulled from the Information Warehouse at Ohio State University. Patients from 2008-2010 with an A1c greater than 9% were selected, and were assessed for readmission within 1 month or 6 months after discharge. A total of 2,265 patients were studied in the 1 month analysis and 2,069 patients were assessed in the 6 month analysis. The patients selected had some sort of diabetes education consult order from their physician. Diabetes education ranged from informal education about basic diabetes management skills (how to inject insulin for example) by nurses, to more comprehensive education provided by certified diabetes educators who not only teach basic skills like recognition of hypo/hyperglycemia and meal planning but also advanced skills like insulin pump management and carbohydrate counting, with the comprehensive education based on an American Diabetes Associated-accredited program. The results of the retrospective study showed that readmission occurred for about 14% of the patients within 1 month and about 32% of patients were readmitted within 6 months.
In conclusion, formal diabetes education resulted in a 34% reduced odds of all-cause hospital readmissions within 1 month and 20% reduced odds of remission within 6 months. Detailed diabetes education should occur in the inpatient setting, with multiple approaches to diabetes education (follow-up appointments, medication reconciliation, patient education, etc.) the key to being the most effective in patients with poor glycemic control. Further prospective randomized control studies should be conducted to determine whether actual individualized diabetes education improves readmission rate and if so, if it is cost-effective or not.
- Inpatient diabetes education is associated with a decrease in hospital readmission among diabetes with poor glycemic control.
- Diabetes education through multiple outlets and sources is ideal in reducing hospital readmission rates.
- Patients with poor glycemic control stand to benefit the most from education.
Healy, S. J. et al. "Inpatient Diabetes Education Is Associated With Less Frequent HospitalReadmission Among Patients With Poor Glycemic Control" Diabetes Care. 2013;36(10): 2960-2967