In a world first, Royal Melbourne Hospital researchers today published the first ever randomised study of a Proactive Inpatient Diabetes Service (RAPIDS) trial to investigate the effect of comprehensive early intervention for in-hospital patients with diabetes.
Published in the premier diabetes journal, Diabetes Care, the study investigated how early intervention from specialist inpatient diabetes teams who provided bedside management within 24 hours of admission compared with usual care, a referral-based consultation service. The patient’s hospital admission was unrelated to their diabetes condition.
Royal Melbourne Hospital’s Director Diabetes and Endocrinology and lead study researcher, Associate Professor Spiros Fourlanos, said the study of this type, involving more than 1,000 patients found early intervention improved blood glucose levels and reduced hospital acquired infections, a common concern for diabetes patients.
“This research is ground-breaking given at least a quarter of patients admitted to Victorian hospitals have diabetes, in many cases, undiagnosed. Diabetes is the most common chronic condition globally, affecting almost half a billion people,” Associate Professor Fourlanos said.
“This new model of care showed improved outcomes for people with diabetes in hospital and the in-hospital teams used networked blood glucose meters that provided a system for electronic surveillance of blood glucose levels in hospital.
“Diabetes always needs to be treated seriously in and out of hospital, but complications for patients in hospital are higher when patients with extreme blood glucose levels aren’t identified and treated seriously.”
Diabetes Australia Victoria statistics show 27,000 Victorians are diagnosed with the disease every year, the equivalent of 74 cases a day. The Federal Government estimates the total economic and social impact of diabetes on the healthcare system is approximately $1.7 billion per year1.
Royal Melbourne Hospital Endocrinologist and a PhD candidate at the University of Melbourne, Dr Mervyn Kyi, said the proactive approach offered the opportunity to care for people with diabetes immediately while in hospital.
“These findings are significant because they prove early identification and management of in-patients with diabetes decreases hyperglycaemia and hospital-acquired infections,” Dr Kyi said.
He said this was the first major randomised clinical trial in non-critical care that hinted at an improvement in glucose control reduced the risk of acute infection.
“The reduction in infection through this trial was remarkable at around 80 percent. It gives us hope that improving blood glucose levels in hospital can provide immediate benefit by decreasing infection.”
In diabetes, hyperglycaemia refers to chronically high blood glucose levels. Hypoglycaemia is a condition caused by a very low level of blood sugar (glucose) which is the body's main energy source. Hyperglycaemia and hypoglycaemia can cause short and long-term complications in hospital and the community.