Comprehension of Discharge Instructions for Diabetes Therapy and Hospital Readmission

Background: Diabetes is a major contributor to hospital readmissions and health care
expenditures. Previous studies have attempted to identify risk factors for readmission among
patients with diabetes. However, no studies have looked at some potentially important factors
including duration of diabetes, HbA1c, glycemic excursions preceding hospital discharge, and
patient comprehension of discharge instructions provided for home diabetes management. In
this study, we propose to examine patient understanding of instructions for insulin therapy
provided at the time of hospital discharge as a potential risk factor for readmission during
the following 30- and 90-day time periods. In addition, we will examine the contribution of
glycemic excursions obtained in the 48-hour period prior to discharge on patient
understanding of insulin therapy and risk for readmission.

Purpose: The purpose of this study is to identify and explore the existing components of
discharge planning provided to patients with insulin treated diabetes in the inpatient
setting and to examine the contribution of glycemic excursions as well as comprehension of
discharge instructions among patients with diabetes, in predicting hospital readmissions.

Methods: This will be a prospective non-blinded observational study enrolling non-critically
ill, non-pregnant, hospitalized patients aged 18-90 years of age with insulin treated
diabetes and no evidence of baseline cognitive. The participants will be recruited from
August 2017 to December 2018 from the Inpatient Endocrine and Diabetes Consult Services and
from daily reports of patients experiencing BG< 70 mg/dL and >300 mg/dL. Eligible
participants will be called within 24-48 hours following hospital discharge at which time
they will be asked to complete a Diabetes Management Questionnaire to determine their
comprehension of the recommendations provided for home-insulin and other diabetes therapies.
This questionnaire will include questions about the types of insulin being used, the doses
administered, and times given. Patient interviews will be conducted again via a telephone
follow up at approximately 30- and 90-days following discharge with specific questions on
home blood glucose control and ER or hospital visits and/or readmissions. The Clinical and
Translational Science Institute at the University of Pittsburgh will be consulted for
statistical analysis.

Study significance:

This study has the potential to identify modifiable factors that can potentially contribute
to the observed frequency of hospital readmissions among patients with insulin treated
diabetes. This study could also advocate for discharge protocols and close follow up of
patients with insulin-treated diabetes following discharge to ensure appropriate
understanding of discharge instructions for insulin therapy and home diabetes management.

Inclusion Criteria:

- Non-pregnant, non-critically ill, hospitalized patients aged 18-90 years with insulin
treated diabetes in the hospital

Exclusion Criteria:

- Patients admitted with primary diagnosis of hypoglycemia, DKA; or Hyperglycemic
Hyperosmolar Syndrome; patients receiving intravenous narcotic medications; patients
discharged to skilled nursing facilities; patients with cognitive impairment defined
as dementia or delirium documented in the Electronic Medical Record (EMR); patients
with limited life expectancy as determined by "Do Not Resuscitate" Status, or
documentation of receiving palliative care or terminal diagnoses with expected
survival of less than 1 year