Diabetes Education Reduces Hospitalizations

Diabetes classes or visits to a nutritionist by patients with diabetics are associated with lower hospitalization rates and reductions in medical costs, according to new findings published in Diabetes Care. Having had any type of educational visit was associated with $11,571 less in hospital charges per person,

"Self-management is the cornerstone of modern diabetes care, and providing patients with the information, skills, and support they need to manage the disease is a critical issue for health care providers and systems," write Dr. Jessica M. Robbins, of the Philadelphia Department of Public Health, and colleagues with the Urban Diabetes Study.

"Self-management education can be provided in a variety of settings to patients with diabetes using any of a variety of models and methods," they add.

The researchers examined the association between different types of educational visits and hospital admission rates and charges for 18,404 diabetic patients. The team linked the subjects’ primary care data from the Philadelphia Health Care Centers with hospital discharge data from the Pennsylvania Health Care Cost Containment Council. The patients were followed-up for an average of 4.7 years. During that time, the records showed that 1,054 patients (5.7 percent) had at least one diabetes class visit; 1,683 (9.1 percent) had at least one nutritionist visit; and 332 (1.8 percent) had a health education visit.

Overall, 2,465 (13.4 percent) subjects had at least one of any of these educational visits. The authors identified a total of 31,653 hospitalizations for the study population. "The hospitalization rate for patients who had no educational visits during follow-up was 38.1 per person per 100 years," Robbins and colleagues report. "For patients who had at least one educational visit, the hospitalization rate was 34 percent lower at 25.0 per person per 100 years."

Having had any type of educational visit was associated with $11,571 less in hospital charges per person, after accounting for the potential influence of demographic factors, other illnesses, hospitalizations prior to the diabetes diagnosis, and the number of other primary care visits.

Nutritionist visits were associated with the greatest reductions in hospitalizations and hospital charges, according to the investigators, "suggesting that providing these services in the primary care setting may be highly cost-effective for the health care system."

Diabetes Care, April 2008.

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