2374-PUB: Early Diabetes Intervention for High-Risk Cardiology Inpatients

Adverse glycaemia in hospital is associated with worse clinical outcomes. Given the high prevalence of diabetes in the cardiology wards, we introduced an early intervention model of diabetes care in high-risk inpatients aiming to decrease adverse glycaemia. A prospective pre- and post-intervention study was conducted in a tertiary referral hospital cardiology ward. It consisted of an initial 6-month baseline phase of standard care (a ‘reactive’ referral-based diabetes consultation service), followed by an 9-month intervention phase, comprising a ‘proactive’ multidisciplinary inpatient diabetes team (IDT) assisted by networked blood glucose (BG) meter technology. The proactive IDT performed electronic surveillance of capillary BG measurements and provided an early consultation service (within 24 hours of admission), without waiting for referral from the parent team. Consecutive inpatients admitted to the cardiology ward (length of stay >48 hours) at high risk of adverse glycaemia (insulin treatment prior to hospital; or BG <4, >15 or two BG >10 mmol/L in the first 48 hours) were recruited. BG data from day 2 until discharge, along with demographic and clinical features, was collected. The primary outcome was the incidence of adverse glycaemic days (AGD) (rate per 1000 patient-days with any capillary BG measure <4 or >15 mmol/L). Overall, we observed 332 patients (1320patient-days and 4887 BG measurements). Compared to usual care, the incidence of AGD decreased from 405 to 320 per 1000 patient-days (21% decrease, p=0.002) which remained significant after MVA adjustment. During the intervention phase, there was decreased mean (±SD) patient-day BG (10.8 ±3.3 vs. 10.1 ±2.8, p<0.001), decreased patient-days with hyperglycaemia (BG >15 mmol/L) (10.4% vs. 6.1%, p=0.044) with no significant difference in patient-days with hypoglycaemia. Analysis of clinical outcomes is pending. An early intervention model of diabetes care decreased adverse glycaemia in cardiology in patients with diabetes.