Continued follow-up does not improve postoperative HbA1c

Although optimal perioperative treatment for patients with diabetes was linked with improved HbA1c, post-discharge follow-up with a hospital diabetes team did not affect long-term glycemic control, study data showed.

“Hospitalization is an opportunity to intervene and improve long-term glycemic control of patients with poorly controlled diabetes,” Rajesh Garg, MD, of the division of endocrinology, diabetes and hypertension at Brigham and Women’s Hospital and Harvard Medical School, told Endocrine Today. Our study shows that intense intervention around the time of hospitalization continues to have positive effects on HbA1c up to 1 year after discharge. However, we did not find any additional benefit of frequent phone calls by a hospital diabetes team on HbA1c.”

Garg and colleagues randomly assigned 151 adults with HbA1c at least 8% (64 mmol/mol) to usual care (n = 74) or continued care (n = 77) after discharge from the hospital following elective surgery. All patients received perioperative treatment. Those assigned to continuing care were in close contact with a nurse practitioner who called them weekly to monthly, reviewing blood glucose, diet, medications and exercise. Patients assigned to the usual care group continued normal follow-up with their diabetes care providers.

At 1 year, mean HbA1c was 8.2% for the continued care group and 8.5% in the usual care group, the researchers reported. Both groups demonstrated a mean change in HbA1c of ­­–0.7%.

Staff members made a mean 11.3 phone calls per patient to those in the continued care group during the study period, although only a mean 7.4 calls resulted in a conversation with a patient. Garg and colleagues reported that they found no link between a higher number of calls from care providers and a reduction or correction in HbA1c.

Among patients who received insulin (n = 41 for continued care group; n = 53 for usual care), HbA1c fell by a mean 0.5 mmol/mol for continued care and 0.6 mmol/mol for usual care.

“Our study is the largest and most comprehensive study in this field so far,” Garg told Endocrine Today. Optimal management of diabetes during hospitalization is important, but for long-term follow-up, more effective strategies need to be developed.” – by Andy Polhamus

For more information:

Rajesh Garg, MD, can be reached at rgarg@bwh.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.