Effect of Inpatient Diabetes Management on Outpatient Glycemic Control

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00869362
Recruitment Status : Completed
First Posted : March 26, 2009
Results First Posted : November 2, 2012
Last Update Posted : November 4, 2014
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by (Responsible Party):
Deborah Wexler, MD, Massachusetts General Hospital

Brief Summary:
The hypothesis of this study is that using hospital admission to identify patients with poorly controlled diabetes (hemoglobin A1c levels >8%), and intervening during the hospitalization with targeted inpatient diabetes management will improve glycemic control at 3 and 12 months, with inpatient glycemic control, quality of life, and diabetes self-efficacy serving as secondary endpoints.

Condition or disease Intervention/treatment Phase
Diabetes Mellitus, Type 2 Other: Diabetes management team Not Applicable

Detailed Description:
The study is a randomized, controlled trial of targeted inpatient diabetes management versus usual care in 70 general medical and surgical inpatients over age 18 with type 2 diabetes and hemoglobin A1c levels greater than 8% who are followed in Partners-affiliated primary care practices. In addition, we will enroll a prospective chart review cohort matched for age, sex, and HbA1c level whose course we will follow for one year after discharge to determine the patter of glycemia among patients who are not enrolled in a clinical trial.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 31 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Effect of Inpatient Diabetes Management on Outpatient Glycemic Control
Study Start Date : March 2009
Actual Primary Completion Date : July 2011
Actual Study Completion Date : July 2011

Arm Intervention/treatment
Experimental: Diabetes Management Team
Evaluation and management by diabetes management team
Other: Diabetes management team
MD evaluation followed by NP education and and medication titration
No Intervention: Control
Patients receive usual care for diabetes

Primary Outcome Measures :
  1. Hemoglobin A1c [ Time Frame: 6 months from discharge ]
    Change in glycemic control measured by HbA1c change baseline to 6 months

Secondary Outcome Measures :
  1. Average Intervention Effect Over 12 Months After Hospital Discharge [ Time Frame: 12 months from discharge ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age > 18 years
  • Known diagnosis of type 2 diabetes by history with outpatient prescription of oral hypoglycemic medication or insulin
  • Hemoglobin A1c > 8.0% within the prior 12 months, or if not known, fasting blood glucose greater than 200 mg/dl on sliding scale regular insulin.
  • Partners-affiliated primary care physician

Exclusion Criteria:

  • Screening HbA1c returns less than 8%.
  • Diabetic ketoacidosis (DKA) as a primary reason for admission (admission blood glucose > 250 mg/dl with arterial pH < 7.30 or serum bicarbonate level < 15 mg/dl), or development of DKA during admission.
  • Hyperosmolar hyperglycemic syndrome as a primary reason for admission (admission blood glucose > 400 mg/dl and plasma osmolality > 315 mOsm/kg.
  • Pregnancy, ruled out by urine HCG test at screening after consent is obtained in all women who continue to have menstrual cycles.
  • Anemia with hemoglobin < 9 g/dl, recent blood transfusion, or need for blood transfusion (interferes with interpretation of hemoglobin A1c assay)
  • End stage liver disease with prothrombin time > 15 seconds and albumin <3 mg/dl
  • End stage renal disease: Stage IV (glomerular filtration rate <30 mg/dl) or V chronic kidney disease
  • Treatment with corticosteroids
  • ICU transfer
  • Inability to self-administer insulin
  • Hypoglycemia unawareness: patient lacks sensation of common signs of blood glucose < 60 mg/dl (tachycardia, diaphoresis, hunger, confusion, fatigue).
  • Projected survival < 1 year

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00869362

United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Principal Investigator: Deborah J Wexler, MD, MSc Massachusetts General Hospital

Publications of Results:
Responsible Party: Deborah Wexler, MD, Principal Investigator, Massachusetts General Hospital Identifier: NCT00869362     History of Changes
Other Study ID Numbers: 2008P-001439
K23DK080228 ( U.S. NIH Grant/Contract )
First Posted: March 26, 2009    Key Record Dates
Results First Posted: November 2, 2012
Last Update Posted: November 4, 2014
Last Verified: October 2014

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases