SUN-850 - Impact of Having an Inpatient Certified Diabetes Care and Education Specialist on Patient Outcomes

Introduction and

Objectives:

The American Diabetes Association recommends that all individuals with diabetes receive diabetes self-management education and support (DSMES) to promote informed decision-making, effective self-care, and collaboration with the healthcare team. Studies have shown that inpatient diabetes education can significantly improve post-discharge outcomes, including reductions in hospital readmissions, sustained improvements in glycemic control, and patient satisfaction. Certified Diabetes Care and Education Specialists (CDCES) play a key role in delivering these services. The aim of this study was to assess the effects of having a dedicated inpatient CDCES in a community hospital setting.

Methods

This retrospective cohort study examined adult (age > 18y) inpatients with diabetes at Johns Hopkins Howard County Medical Center, a 262 bed hospital in suburban Maryland, comparing time periods prior to having a dedicated full-time inpatient CDCES on staff (“pre-CDCES”, February 1, 2023 to September 27, 2023) to a time period with a CDCES (“post-CDCES”, September 28, 2023 to December 31, 2024). Only a patient’s initial hospitalization was included in analyses. High risk patients were defined as those with type 1 diabetes, discharged on insulin, or having hypoglycemia during the admission. The primary outcome was 30-day readmission rate (30DRR).  Chi square, Student’s t-test, Mann Whitney U, and multivariate logistic regression tests were used to compare between groups. Age, sex, endocrine consultation, and high risk were covariates in the models.

Results:

A total of 7943 patients were assessed, 2708 in the pre-CDCES cohort and 5235 in the post-CDCES cohort. Baseline characteristics were similar between cohorts (age: 68.0±14.9 vs 68.7±15.6y, sex: 50.1 vs 51.2%female, high risk: 46.4 vs 46.9%). The CDCES saw 572 patients, 75.7% of whom were high risk. Between cohorts, 30DRR significantly decreased among all patients (17.5 vs 14.9%, p=0.003) and high-risk patients (21.3 vs 17.5%, p=0.005). After adjusting for covariates, seeing an inpatient CDCES significantly reduced 30DRR among all patients (OR 0.59, 95%CI 0.44-0.78; p< 0.001), as well as high-risk patients (OR 0.64, 95%CI 0.47-0.88; p< 0.01).

Conclusion:

Implementation of a dedicated full-time inpatient CDCES in a community hospital was associated with a significant reduction in 30-day readmission rates among hospitalized adults with diabetes, including those at high risk. These findings highlight the critical role of inpatient diabetes education and support in improving post-discharge outcomes and underscore the value of integrating CDCES services into inpatient care models.

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