A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause-effect relationship between hypoglycaemia and the risk of in-hospital mortality.
Aged
Biomarkers
/ analysis
Blood Glucose
/ analysis
Diabetes Mellitus, Type 1
/ mortality
Diabetes Mellitus, Type 2
/ mortality
Female
Follow-Up Studies
Hospital Mortality
/ trends
Hospitalization
/ statistics & numerical data
Humans
Hypoglycemia
/ epidemiology
Inpatients
/ statistics & numerical data
Italy
/ epidemiology
Male
Prognosis
Prospective Studies
Survival Rate
clinical outcomes
diabetes
governance
hypoglycaemia
in-hospital
performance score
Journal
Diabetes/metabolism research and reviews
ISSN: 1520-7560
Titre abrégé: Diabetes Metab Res Rev
Pays: England
ID NLM: 100883450
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
19
03
2020
revised:
04
05
2020
accepted:
10
05
2020
pubmed:
24
5
2020
medline:
12
10
2021
entrez:
24
5
2020
Statut:
ppublish
Résumé
To build a tool to assess the management of inpatients with diabetes mellitus and to investigate its relationship, if any, with clinical outcomes. A total of 678 patients from different settings, Internal Medicine (IMU, n = 255), General Surgery (GSU, n = 230) and Intensive Care (ICU, n = 193) Units, were enrolled. A work-flow of clinical care of diabetes was created according to guidelines. The workflow was divided into five different domains: (a) initial assessment; (b) glucose monitoring; (c) medical therapy; (d) consultancies; (e) discharge. Each domain was assessed by a performance score (PS), computed as the sum of the scores achieved in a set of indicators of clinical appropriateness, management and patient empowerment. Appropriate glucose goals were included as intermediate phenotypes. Clinical outcomes included: hypoglycaemia, survival rate and clinical conditions at discharge. The total PS and those of initial assessment and glucose monitoring were significantly lower in GSU with respect to IMU and ICU (P < .0001). The glucose monitoring PS was associated with lower risk of hypoglycaemia (OR = 0.55; P < .0001), whereas both the PSs of glucose monitoring and medical therapy resulted associated with higher in-hospital survival only in the IMU ward (OR = 6.67 P = .001 and OR = 2.38 P = .03, respectively). Instrumental variable analysis with the aid of PS of glucose monitoring showed that hypoglycaemia may play a causal role in in-hospital mortality (P = .04). The quality of in-hospital care of diabetes may affect patient outcomes, including glucose control and the risk of hypoglycaemia, and through the latter it may influence the risk of in-hospital mortality.
Substances chimiques
Biomarkers
0
Blood Glucose
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3347Subventions
Organisme : Programma di Ricerca RER/-Università 2010-2012-Area 2 Ricerca per il Governo Clinico
Pays : International
Informations de copyright
© 2020 John Wiley & Sons Ltd.
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