Two coinciding studies have identified – and are trying to improve – the increased risk of patients with diabetes contracting infections and suffering acute kidney injury and stroke when in hospital. 

The DINGO and STOIC-D studies, led by the RMH, were successive studies that assessed the risks for patients who live with diabetes while admitted to hospital.   

First, they identified that patients with diabetes who also have hyperglycemia are at higher risk of infection, acute kidney injury and stroke during their stay.  

Then, they developed a tool to find these patients and intervene to prevent further injuries and infection from occurring. This was done via an electronic alert that earmarked at-risk patients for an early consult by a specialist inpatient diabetes team who could better recommend therapies and treatment plans. 

“This early specialist-led model of care not only reduced glucose, but markedly reduced infections picked up in hospital. This means we now have a tool to improve the worse outcomes of people with diabetes in hospital," Dr Rahul Barmanray, an endocrinologist at the RMH and lead author of the studies, said. 

The impact was measured via a new way of summarising blood sugar readings called the patient-day mean glucose (PDMG) – measured in millimoles per litre (mmol/L) – which reflects a person’s average exposure to glucose. Typically, the lower the reading, the better. 

And the results were positive.  

Of the 1371 admissions that met the STOIC-D study’s inclusion criteria between February and December 2021, 680 were given early intervention treatment while 691 were treated with standard diabetes care. The first group were found to have a lower PDMG of 8.2 mmol/L while the other group came in at 8.6 mmol/L.  

The study also found their risk of healthcare associated infection declined by about 4 per cent when early intervention was used. 

“It's long been known that people with diabetes get more infections, have more hospital admissions, and are more likely to get an infection when admitted to hospital than people without diabetes,” Dr Barmanray said.  

“It's also known that high glucose contributes to increased infections.  

“This study represents the highest level of evidence - a randomised controlled trial - showing the effectiveness of specialists using electronic tools to manage glucose early in the course of hospital admissions for people with diabetes.” 

He added that the STOIC-D Surgery study is the largest trial to date of such a team and represents the only individually randomised, controlled trial to date to show an improvement in glucose-related adverse outcomes. 

The results were published earlier this year in the prestigious journal Diabetes Care.  

Mobile Stroke Unit with Ambulance Victoria paramedic and the RMH Stroke team
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