Diabetes in reach team involvement could help improve inpatient deintensification rate in people with diabetes and frailty

Abstract

Introduction: Our previous study has shown low rates of inpatient deintensification and high rates of adverse outcomes in people with diabetes and frailty1,2. The diabetes in reach (DiR) team consists of diabetologists working together with diabetes specialist nurses, proactively supporting non-specialists in the inpatient management of diabetes. This could be done either virtually or by face-to-face review in the medical ward. This study assessed the role of the DiR team in improving care for inpatients with diabetes and frailty. Materials and methods: We included all people with diabetes and clinical frailty score ≥ 6 discharged from our medical unit in the year 2022. Data including demographics, medications and comorbidities were collected. Inpatient management and outcomes collected include involvement of the DiR team, deintensification rate, inpatient hypoglycaemia (defined by any episode of capillary blood glucose of < 4 mmol/L), inpatient mortality and 1-month readmission rates. Results and discussion: Six hundred and sixty-five people with diabetes and frailty were included in our analysis. 51.9% (n = 345/665) were female with a median age of 79 years (71-86). 19% (n = 119/625) were deintensified during admission. DiR teams were involved in the care of 26.8% (n = 178/665) of the patients. People with inpatient hypoglycaemia were more likely to be reviewed by the DiR team compared to those without hypoglycaemia [aOR: 5.7 (95% CI: 3.7–8.6), p<0.001]. In patients who were deintensified, deintensification was done by the parent team in 38.7% (n = 46/119) and 61.3% (n=73/119) by the DiR team. Irrespective of hypoglycaemia, being reviewed by the DiR team was associated with increased odds of deintensification compared to those that were not reviewed by the DiR team [aOR: 4.2 (95% CI: 2.6–6.8), p<0.001]. No associations were seen between being reviewed by DiR with inpatient mortality and readmission rate. Conclusion: The majority of inpatient deintensification in people with diabetes and frailty was initiated by the DiR team, compared to the parent team. DiR could play an effective and important role in improving the inpatient deintensification rate in people with diabetes and frailty.