Implementation and Testing of a Diabetes Discharge Intervention to Improve Safety During Transitions of Care

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Project Summary A substantial number of patients develop type 2 diabetes mellitus (DM) during their lifetime and need diabetes medications. However, poor glycemic control (hypo (low) - and hyper- (high) glycemia or blood sugar) from unsafe medication use is known to contribute to both complications and mortality. Therefore, assuring DM patients' ability to appropriately manage glycemic control after high risk times, such as hospital discharge, is critical. In a prior study, we identified high risk failures in the discharge process of patients with DM, including variability in comprehension and standardization of diabetes education. To address these failures, we developed a Diabetes Discharge Toolkit, a hands-on teaching kit for patients and providers with an integrated website and app for both inpatient and outpatient use, utilizing a user-centered design approach. The goal of this proposal is to integrate and implement the Diabetes Discharge Toolkit to improve the quality and safety of the transition of DM care from hospital to home for patients newly prescribed insulin. We will then assess the adequacy of implementation to ensure appropriate fidelity of the proposed intervention in this transitional care setting. Following, we will conduct a randomized controlled trial of the intervention to test the efficacy of the Toolkit and to assess its impact on reducing hyper- and hypoglycemia, following hospital discharge. We then propose to disseminate our findings for future use of the Toolkit throughout our institution and at the local level through a local collaboration with our diabetes association. There is a clear need for improvement in DM transitions of care, and improvement in the safe use of DM medications, given that they are a high risk population. This intervention has the potential to be generalized to DM care in other care settings (e.g., emergency department, outpatient clinic) for DM patients.