Impact of a Diabetes Transitions Tool Kit on Post-Hospitalization Glycemic Control
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/13/2015 |
| Start Date: | December 2011 |
| End Date: | July 2013 |
| Contact: | Nancy J Wei, MD |
| Email: | ncwei@partners.org |
| Phone: | 617-724-7597 |
Impact of a Web-based Diabetes Transitions Tool Kit on Post-Hospitalization Glycemic Control
The goal of this research is to evaluate the impact and feasibility of using web-based
patient-provider communication and a remote glucose monitoring tool to improve
post-hospitalization glycemic control and patient self-care. The investigators hypothesize
that providing patients this web-based tool over a 4-week period after discharge to home
will result in more effective glycemic control compared to usual care, and that patients
with access to the "tool kit" will have a trend towards improved diabetes self-management
and less diabetes-related distress.
patient-provider communication and a remote glucose monitoring tool to improve
post-hospitalization glycemic control and patient self-care. The investigators hypothesize
that providing patients this web-based tool over a 4-week period after discharge to home
will result in more effective glycemic control compared to usual care, and that patients
with access to the "tool kit" will have a trend towards improved diabetes self-management
and less diabetes-related distress.
Diabetes affects 12-25% of all hospitalized adult patients, and 30% of hospitalized diabetes
patients have one or more readmissions within one year. While glycemic control is rarely the
primary reason for admission, poor glycemic control has been associated with increased rates
of hospitalization and worse clinical outcomes, including infections, poor wound healing,
and death. Hospitalization has been proposed as a "teachable moment" for patients with
diabetes, as they have intensive contact with a full range of expert clinicians, but the
effects of changes implemented during hospitalization after discharge are poorly studied.
The objective of this study is to conduct a randomized controlled trial to test a novel
approach to diabetes management in the transition from inpatient to outpatient care. We will
assign 40 hospitalized adult patients with type 2 diabetes to usual care or access to a
web-based patient-provider communication and remote glucose monitoring tool ("Diabetes
Transitions Tool Kit"). Our aims are to evaluate feasibility of implementation of the tool
as well as impact on post-discharge glycemic control, diabetes-related self-care and
distress. We hypothesize that providing patients this web-based tool over a 4-week period
after discharge to home will result in more effective glycemic control compared to usual
care, and that patients with access to the "tool kit" will have a trend towards improved
diabetes self-management and less diabetes-related distress. Feasibility and preliminary
data from this pilot study will be the foundation for larger-scale interventions that may
ultimately improve the delivery of diabetes care in the transition from hospital to home.
patients have one or more readmissions within one year. While glycemic control is rarely the
primary reason for admission, poor glycemic control has been associated with increased rates
of hospitalization and worse clinical outcomes, including infections, poor wound healing,
and death. Hospitalization has been proposed as a "teachable moment" for patients with
diabetes, as they have intensive contact with a full range of expert clinicians, but the
effects of changes implemented during hospitalization after discharge are poorly studied.
The objective of this study is to conduct a randomized controlled trial to test a novel
approach to diabetes management in the transition from inpatient to outpatient care. We will
assign 40 hospitalized adult patients with type 2 diabetes to usual care or access to a
web-based patient-provider communication and remote glucose monitoring tool ("Diabetes
Transitions Tool Kit"). Our aims are to evaluate feasibility of implementation of the tool
as well as impact on post-discharge glycemic control, diabetes-related self-care and
distress. We hypothesize that providing patients this web-based tool over a 4-week period
after discharge to home will result in more effective glycemic control compared to usual
care, and that patients with access to the "tool kit" will have a trend towards improved
diabetes self-management and less diabetes-related distress. Feasibility and preliminary
data from this pilot study will be the foundation for larger-scale interventions that may
ultimately improve the delivery of diabetes care in the transition from hospital to home.
Inclusion Criteria:
- Age 18 years or older
- English speaking and able to read English
- Diagnosis of type 2 diabetes (new and pre-existing)
- Hospital admission with endocrinology or inpatient diabetes management consult
- On insulin during hospitalization with plan for continuation upon discharge.
- Discharge planned for home.
- Access to the internet and an active email account throughout the 6-week study
period.
Exclusion Criteria:
- Inability to connect to, navigate, and utilize the web-based system, or designate
someone who is capable of using the system.
- No identifiable outpatient healthcare provider.
- Pregnancy, ruled out by urine hCG test after consent is obtained in all women who
continue to have menstrual cycles.
- End-stage liver disease with prothrombin time >15 seconds and albumin <3 mg/dL.
- Hypoglycemia unawareness: patient lacks sensation of common signs of blood glucose
<60 mg/dL (tachycardia, diaphoresis, hunger, confusion, fatigue).
- Projected survival <1 year.
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