Efficacy of a training programme for the management of diabetes mellitus in the hospital: A randomized study (stage 2 of GOVEPAZ healthcare)

Abstract

AimsTo assess the efficacy of a structured educational intervention for health professionals on the appropriateness of inpatient diabetes care and on some clinical outcomes in hospitalised subjects.MethodsA multicentre (6 regional hospitals) cluster‐randomized (2:1) two parallel‐group pragmatic intervention trials, as a part of the GOVEPAZ study, was conducted in three clinical settings, that is, Internal Medicine, Surgery and Intensive Care. Intervention consisted of a 2‐month structured education of clinical staff to inpatient diabetes care. Twelve wards ‐ 2 for each hospital ‐ and 6 wards ‐ 1 for each hospital ‐ were randomized to usual care and to the intervention arm, respectively. Consecutively hospitalised diabetic subjects (n = 524, age 74 ± 14 years, 57% males, median HbA1C 57 mmol/mol) were included. The clinical appropriateness of inpatient diabetes management was assessed by a previously validated multi‐domain performance score (PS). Clinical outcomes included hypoglycemia, glucose control biomarkers, clinical conditions at discharge and inpatient mortality rate.ResultsA numerically, but not statistically significant, higher PS (+0.94; 95% C.I.: −0.53 ‐ +2.4) was achieved in the intervention than in the usual care wards. Hypoglycemias (p = 0.32), glucose control (p = 0.89) and survival rates (p = 0.71) were similar in the two experimental arms. Plasma glucose on admission (OR = 1.52 per 1 SD; C.I. 1.07–2.17; p = 0.021) and the number of hypoglycemic events per patient (OR = 1.55 per 1 SD; C.I.:1.11–2.16; p = 0.011) were independently associated with the inpatient mortality rate.ConclusionsStructured education of the clinical staff failed to improve the inpatient appropriateness of diabetes care or clinical outcomes. In‐hospital hypoglycemia was confirmed to be an independent indicator of death risk.