Background Although the use of electronic order sets has become standard practice for inpatient diabetes management, there is limited decision support at discharge. Objective In this study, we assessed whether an electronic discharge order set (DOS) plus nurse follow-up calls improve discharge orders and postdischarge outcomes among hospitalized patients with type 2 diabetes mellitus. Methods This was a randomized, open-label, single center study that compared an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with type 2 diabetes mellitus. The primary outcome was change in glycated hemoglobin (HbA1c) level at 24 weeks after discharge. The secondary outcomes included the completeness and accuracy of discharge prescriptions related to diabetes. Results This study was stopped early because of feasibility concerns related to the long-term follow-up. However, 158 participants were enrolled (DOS: n=82; ESC: n=76), of whom 155 had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (78% vs 44%; P=.01), needles or syringes (95% vs 63%; P=.03), and glucometers (86% vs 36%; P<.001). The clarity of the orders was similar. HbA1c data were available for 54 participants in each arm at 12 weeks and for 44 and 45 participants in the DOS and ESC arms, respectively, at 24 weeks. The unadjusted difference in change in HbA1c level (DOS – ESC) was −0.6% (SD 0.4%; P=.18) at 12 weeks and −1.1% (SD 0.4%; P=.01) at 24 weeks. The adjusted difference in change in HbA1c level was −0.5% (SD 0.4%; P=.20) at 12 weeks and −0.7% (SD 0.4%; P=.09) at 24 weeks. The achievement of the individualized HbA1c target was greater in the DOS group at 12 weeks but not at 24 weeks. Conclusions An intervention that included a DOS plus a postdischarge nurse phone call resulted in more complete discharge prescriptions. The assessment of postdischarge outcomes was limited, owing to the loss of the long-term follow-up, but it suggested a possible benefit in glucose control. Trial Registration ClinicalTrials.gov NCT03455985; https://clinicaltrials.gov/ct2/show/NCT03455985

Objective To evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D). Methods This is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days). Results A1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate −0.21, 95% CI −0.40, −0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days. Conclusion The study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions. Clinical Trial NCT03455985.

BACKGROUND While electronic order sets have become standard practice for inpatient diabetes management, there is limited decision support at discharge. OBJECTIVE This study assessed whether an electronic discharge order set (DOS) plus nurse follow up calls improves discharge orders and post-discharge outcomes among hospitalized patients with type 2 diabetes (T2D). METHODS This is a randomized open label single center study comparing an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with T2D. The primary outcome was change in HbA1c at 24 weeks post-discharge. Secondary outcomes included completeness and accuracy of discharge prescriptions related to diabetes. RESULTS The study was stopped early due to feasibility concerns related to long-term follow-up. However a total of 158 subjects were enrolled (DOS=82, ESC=76), 155 of whom had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (81% vs 44%; P=0.01), needles/syringes (95% vs 63%; P=0.03), and glucometers (86% vs 36%; P=0.0002). Clarity of orders was similar. HbA1c was available in 27 subjects in each arm at 12 weeks, and 20/21 subjects in the DOS/ESC arms at 24 weeks. The adjusted difference in change in HbA1c (DOS-ESC) was -0.5 ± 0.4% at 12 weeks (P = 0.20) and -0.7 ± 0.4% at 24 weeks (P= 0.09). Achievement of individualized HbA1c target was greater in the DOS group at 12 weeks but not 24 weeks. CONCLUSIONS A DOS resulted in more complete discharge prescriptions. Assessment of post-discharge outcomes was limited due to loss of long-term follow-up but suggests possible benefit in glucose control. CLINICALTRIAL NCT03455985 Effectiveness of a Diabetes Focused Discharge Order Set Among Poorly Controlled Hospitalized Patients Transitioning to Glargine U300 Insulin