title: Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge.
abstract: OBJECTIVE
  To determine whether inpatient diabetes management and education with improved transition to outpatient care (IDMET) improves glycemic control after hospital discharge in patients with uncontrolled type 2 diabetes (T2DM).
  
  
  METHODS
  Adult inpatients with T2DM and HbA1c > 7.5% (58 mmol/mol) admitted for reasons other than diabetes to an academic medical center were randomly assigned to either IDMET or usual care (UC). Linear mixed models estimated treatment-dependent differences in the change in HbA1c (measured at 3, 6, and 12 months) from baseline to 1-year follow-up.
  
  
  RESULTS
  Thirty-one subjects had mean age 55 ± 12.6 years, with mean HbA1c of 9.7 ± 1.6% (82 ± 18 mmol/mol). Mean inpatient glucose was lower in the IDMET than in the UC group (176 ± 66 versus 195 ± 74 mg/dl [9.7 versus 10.8 mmol/l], P = 0.001). In the year after discharge, the average HbA1c reduction was greater in the IDMET group compared with the UC group by 0.6% (SE 0.5%, [7 (SE 5)mmol/mol], P = 0.3). Among patients newly discharged on insulin, the average HbA1c reduction was greater in the in the IDMET group than in the UC group by 2.4% (SE 1.0%, [25 (SE 11)mmol/mol], P = 0.04).
  
  
  CONCLUSIONS
  Inpatient diabetes management (IDMET) substantially improved glycemic control 1 year after discharge in patients newly discharged on insulin; patients previously treated with insulin did not benefit.
authors.affiliation: Massachusetts General Hospital Diabetes Center, Boston, MA 02114, USA. dwexler@partners.org
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Wexler
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Beauharnais
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.forename: Enrico
authors.initials: E
authors.lastname: Cagliero
authors.forename: Mary E
authors.initials: ME
authors.lastname: Larkin
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients / Q000706:statistics & numerical data; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin