IMPACT OF ELECTIVE HOSPITALIZATION OF POORLY CONTROLLED DIABETIC PATIENTS ON SHORT TERM GLYCEAMIC CONTROL

The primary aim of this study was to determine whether elective admission of poorly controlled diabetic patients to the hospital for glycaemic control through medical therapy and education has an impact on the short-term glycaemic control up to six months post hospital discharge. The secondary objective is to determine the length of hospital stay (days) and the effect of inpatient management on the body weight (kilograms) and the incidence of severe post hospital discharge hypoglycaemia. This is a retrospective study of 55 poorly controlled type 1 and type 2 diabetic patients who were electively admitted for glycaemic control under the care of the endocrine service at King Faisal Specialist Hospital and Research Center (KFSH RC), Riyadh Saudi, Arabia, from the period 1996-2000. Only those with HbA1c 8.5% and have follow up data up to 6 months post discharge (mean 3.4 ± 2.2 months) were included. Patients with acute metabolic complications, gestational and newly diagnosed diabetes mellitus and those receiving insulin analogs were excluded. Paired t-test is used to compare the result of baseline and post discharge HbA1c, body weight (Kg). HbA1c was decreased significantly in the whole group from a baseline value of 13.5 ± 2.4 to 11.4 ± 2.1%, within a mean period of3.4 ± 2.2 months post hospital discharge (p 0.0001). In type 1 DM, HbA1c decreased from a baseline value of 14.8 ± 3.0 to 12.5 ± 3.0 (p = 0.006). Similarly in type 2 DM, HbA1c fell from a baseline value of 13.1 ± 2.0 to 11.1 ± 2.0 (p 0.0001). On the other hand the body weight increased from a baseline value of 70.9 ± 16.5 Kg to 72.8 ± 16.5 Kg (p 0.0001). The increase in body weight was obvious in both type 1 and type 2 DM with a baseline value of 65.7 ± 17 Kg and 72.4 ± 16.2 Kg to 67 ± 17.45 Kg and 74.6 ± 16 Kg respectively during the study period. The length of hospital stay was 4.6 ± 2.39 days for type 1 DM and 5.3 ± 2.2 days for type 2 DM patients. Elective hospitalisation of uncontrolled type 1 or type 2 DM under the care of multidisciplinary team had a significant positive impact on glycaemic control with a significant reduction of baseline mean HbA1c of 2.1% in the short term. This is more obvious in patients who had increase in their diabetic medication(s) or who were switched to insulin therapy