Inpatient diabetes care: Strategies for disease management

Diabetes is a chronic condition with high morbidity, mortality, and prevalence rates that results in high human and financial costs. Coordinating diabetes care with a disease management approach that stresses comprehensive, proactive, and evidence-based strategies is essential if the human and financial costs of diabetes are to be reduced. Most patients do not receive the essential care processes recommended by the American Diabetes Association (ADA) that could reduce the human and financial costs. One reason the ADA standards are not being met is the tendency of our healthcare system to utilize resources for acute events, rather than the management of chronic diseases. We believe that the frequent episodes of hospitalization for patients with diabetes represent missed opportunities to improve their overall diabetes care. This is a descriptive report involving a large tertiary medical center in New York City, where the disease management approach has been used to develop diabetes-related inpatient interventions. The inpatient disease management tools described are a blood glucose monitoring form with color-coded algorithms, an inpatient type 2 diabetes clinical pathway for diabetes as a secondary diagnosis, an inpatient brochure, and a patient follow-up letter reporting hemoglobin A(1c) levels measured during hospitalization. These tools have the potential to achieve 2 important goals: improved glycemic management for patients while hospitalized and the provision of a critical link between inpatient and ambulatory diabetes care. These tools will help achieve the ADA standards and may reduce the morbidity of diabetes.