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Inpatient Diabetes Education in the Real World: an Overview of Guidelines and Delivery Models

  • Hospital Management of Diabetes (A Wallia and JJ Seley, Section Editors)
  • Published:
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Abstract

Purpose of Review

Diabetes self-management education and support improves diabetes-related outcomes, yet less than 50% of persons with diabetes in the USA receive this service. Hospital admissions present a critical opportunity for providing diabetes education. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available.

Recent Findings

As diabetes rates continue to soar and adults with diabetes continue to have high hospitalization and readmission rates, hospitals face challenges in assessing and meeting diabetes patients’ educational needs. The consensus recommendation for inpatient diabetes teaching is to provide survival skills education to enable safe self-management following discharge until more comprehensive outpatient education can be provided. Established and emerging models for delivery of diabetes survival skills education in the hospital may be broadly grouped as diabetes-specialty care models, diabetes non-specialty care models, and technology-supported diabetes education. These models are often shaped by the availability of diabetes specialists, including endocrinologists and diabetes educators—or lack thereof, and staffing resources for provision of services. Recent studies suggest that all three approaches can be deployed successfully if well planned.

Summary

This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. The authors seek to make the reader aware of the heterogeneous approaches that are being implemented nationwide for inpatient diabetes education delivery. Meeting inpatient diabetes educational needs will require a sustained effort, diverse strategies based on resources available, and additional research to explore the impact of these strategies on outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926–43. Findings from this review provide additional support for the effectiveness of DSME and its positive effect on glycemic control.

    Article  Google Scholar 

  2. Magee MF, Khan NH, Desale S, Nassar CMK. Diabetes to go: knowledge and competency-based hospital survival skills education program improves post-discharge medication adherence. Diabetes Educ. 2014;40(3):344–50.

    Article  Google Scholar 

  3. Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care. 2013;36:2960–7.

    Article  Google Scholar 

  4. Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S. Centers for disease control and prevention. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes—United States, 2011–2012. MMWR Morb Mortal Wkly Rep. 2014;63:1045–9.

    PubMed  PubMed Central  Google Scholar 

  5. National Center for Health statistics diabetes management benefit use: diabetic older adults (internet). Available from: http://www.healthindicators.gov/Indicators/Diabetesmanagement-benefit-use-diabetic-older-adultspercent_1263/Profile/ClassicData. Accessed 26 April 2019.

  6. New CDC report: More than 100 million Americans have diabetes or prediabetes. 2017. Available from: https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html. Accessed 26 April 2019.

  7. American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36:1033–46.

    Article  Google Scholar 

  8. Rubin DJ, Donnell-Jackson K, Jhingan R, Golden SH, Paranjape A. Early readmission among patients with diabetes: a qualitative assessment of contributing factors. J Diabetes Complicat. 2014;28(6):86973.

    Article  Google Scholar 

  9. Dungan K, Lyons S, Manu K, Kulkarni M, Ebrahim K, Grantier C, et al. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocr Pract. 2014;20(12):1265–73.

    PubMed  Google Scholar 

  10. • Kuniss N, Muller UA. Substantial improvement in HbA1c following a treatment and teaching programme for people with type 2 diabetes on conventional insulin therapy in an in- and outpatient setting. Acta Diabetol. 2017. https://doi.org/10.1007/s00592-017-1070-2. Findings from this study suggest that a patient education intervention targeting optimization of insulin therapy in persons with type 2 diabetes was equally effective whether provided in the inpatient or outpatient setting.

    Article  Google Scholar 

  11. American Diabetes Association. Diabetes care in the hospital: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl. 1:S173–81.

    Article  Google Scholar 

  12. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer R, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553–91.

    Article  Google Scholar 

  13. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American association of clinical endocrinologists and American Diabetes Association Consensus Statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.

    Article  Google Scholar 

  14. Rubin DJ, Meneghini LF, Seley JJ, Cagliero E, Gaudiani M, Gilden GL. Transition of care: discharge from the hospital. In: Draznin B, editor. Managing diabetes and hyperglycemia in the hospital setting a clinician’s guide. American Diabetes Association, 2016; pp. 381–388.

  15. Donihi AC. Practical recommendations for transitioning patients with type 2 diabetes from hospital to home. Curr Diab Rep. 2017;17(7):52.

    Article  Google Scholar 

  16. Revisions to advanced certification requirements for inpatient diabetes care. Available from: https://www.jointcommission.org/assets/1/6/Cert_Inpatient_Diabetes.pdf. Accessed 5/1/2019.

  17. American Association of Diabetes Educators Position Statement: Role of the diabetes educator in inpatient diabetes management. 2016. Available at: https://www.diabeteseducator.org/docs/default-source/practice/practice-documents/position-statements/role-of-the-diabetes-educator-in-inpatient-diabetes-management.pdf?sfvrsn=2. Accessed May 1, 2019.

  18. Rinker J, Dickinson JK, Litchman ML, Williams AS, Kolb LE, Cox C, et al. The 2017 diabetes educator and the diabetes self-management education national practice survey. Diabetes Educ. 2018;44(3):260–8.

    Article  Google Scholar 

  19. Hellman R. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocr Pract. 2014;20(10):10971099.

    Article  Google Scholar 

  20. •• Bansal V, Mottlib A, Pawar TK, Abbasakoor N, Chuang E, Chaudry A, et al. Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical units: impact on 30-day readmission rate and hospital cost. BMJ Open Diabetes Res Care. 2018. https://doi.org/10.1136/bmjdrc-2017-000460. Findings from this study suggest that a specialized diabetes team providing inpatient diabetes care can reduce 30-day readmissions to non-critical care units by 30% as compared to standard diabetes care provided by a primary care team; as well as decrease hospital costs.

    Article  Google Scholar 

  21. Wexler DJ, Beauharnais CC, Regan S, Nathan DM, Cagliero E, Larkin ME. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract. 2012;98(2):249–56.

    Article  Google Scholar 

  22. Ulisse G. Implementation of an inpatient diabetes management team in the university hospital setting. Diabetes Spectrum. 2010;23(2):131–3.

    Article  Google Scholar 

  23. Munoz M, Pronovost P, Dintzis J, Kemmerer T, Wang N, Chang Y, et al. Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice. Jt Comm J Qual Patient Saf. 2012;38(5):195–206.

    Article  Google Scholar 

  24. DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Rhee C, Wells A, et al. Inpatient management of hyperglycemia: the northwestern experience. Endocr Pract. 2006;12:491–505.

    Article  Google Scholar 

  25. Hardee SG, Osborne KC, Njuguna N, Allis D, Brewington D, Patil SP, et al. Interdisciplinary diabetes care: a new model for inpatient diabetes education. Diabetes Spectrum. 2015;28(4):276–82.

    Article  Google Scholar 

  26. Krall JS, Donihi AC, Hatam M, Koshinsky J, Siminerio L. The nurse education and transition (NEAT) model: educating the hospitalized patient with diabetes. Clin Diabetes and Endocr. 2016. https://doi.org/10.1186/s40842-016-0020-1.

  27. Murphy JA, Schroeder MN, Ridner AT, Whitner JB. Impact of a pharmacy-initiated inpatient diabetes patient education program on 30-day readmission rates. J Pharm Pract. 2019. https://doi.org/10.1117/897190019833217.

  28. Healthwise, available at https://www.healthwise.org/solutions/health-systems.aspx. Accessed May 28, 2019.

  29. Shipman JP, Lake EW, Volgen JVD, Doman D. Provider documentation of patient education: a lean investigation. J Med Libr Assoc. 2016;104:154–8.

    Article  Google Scholar 

  30. Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc. 2014;21:742–50.

    Article  Google Scholar 

  31. Smith KM, Baker KM, Bardsley JK, McCartney P, Magee M. Redesigning hospital diabetes education: a qualitative evaluation with nursing teams. J Nurs Care Qual. 2018;34(2):151–7.

    Article  Google Scholar 

  32. Youssef G, Ip EH, Magee M, Chen SH, Wallia A, Pollack T, et al. Validity and reliability of a (brief) diabetes “survival skills” knowledge test: KNOW diabetes. Diabetes Educ. 2019, 34(2):151–157.;;45(2):184–93.

    Article  Google Scholar 

  33. Lorenzi N. Health facilities management magazine. Patient television systems – educational and clinical applications provide improved engagement. 2014. https://www.hfmmagazine.com/articles/1361-patient-television-systems. Accessed May 28, 2019.

  34. Orr N, Catsi G, Guirguis N, Balafas A, Rissel C. The use of closed-circuit hospital channel to promote health. The reach and appeal of PPAtv to patients and visitors. Aust Health Rev. 2007;31(4):527–30.

    Article  Google Scholar 

  35. Voltaire. Dictionnaire Philosophique. 1770.

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Funding

Michelle F. Magee reports grants from NIH-NIDDK (R34-DK 109503).

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Authors and Affiliations

  1. MedStar Health Research Institute, Hyattsville, MD, USA

    Carine M. Nassar & Michelle F. Magee

  2. MedStar Diabetes Institute, Washington, DC, USA

    Carine M. Nassar, Alex Montero & Michelle F. Magee

  3. Georgetown University School of Medicine, Washington, DC, USA

    Alex Montero & Michelle F. Magee

Authors
  1. Carine M. Nassar
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Correspondence to Carine M. Nassar.

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Conflict of Interest

Carine M. Nassar reports other funding from Mytonomy Inc. and Lilly, and institutional support from MedStar Health.

Alex Montero declares no conflict of interest.

Michelle F. Magee reports grants from Mytonomy Inc. and Lilly, speaking fees from the American Diabetes Association, Pri-Med, and Endocrine Society; and institutional support from MedStar Health.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hospital Management of Diabetes

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Nassar, C.M., Montero, A. & Magee, M.F. Inpatient Diabetes Education in the Real World: an Overview of Guidelines and Delivery Models. Curr Diab Rep 19, 103 (2019). https://doi.org/10.1007/s11892-019-1222-6

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  • DOI: https://doi.org/10.1007/s11892-019-1222-6

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