Improving the rates of inpatient HbA_1c assessment and medication deintensification in people with diabetes and frailty.

Abstract

Intensive glucose management in people with diabetes and frailty presents significant risk which outweighs potential benefit. Hospital admission presents an opportunity for interventions that may reduce the impact of overtreatment in people with diabetes and frailty. Our previous study has shown low rates of glycated haemoglobin(HbA_1c) assessment and inpatient medication deintensification in people with diabetes and frailty. We conducted a three-intervention quality improvement programme and studied the effectiveness of the interventions aiming to improve the inpatient HbA_1c assessment and management of inpatients with diabetes and frailty. A baseline assessment was conducted prior to cycles 1 and 2, with another audit conducted post-cycles 1 and 2. A further audit was then carried out with another audit post-cycle 3. Interventions 1 and 2 involved publishing an infographic to aid assessment and medication deintensification in patients with diabetes and frailty, followed by spreading awareness among resident doctors of the baseline audit results and the infographic via email and WhatsApp groups. Intervention 3 involved allocating 'Diafrailty Champion' the medical wards to help improve the assessment and management of patients with diabetes and frailty. A total of 291 patients with diabetes and moderate-severe frailty were included in our audits (96 patients in baseline audit, 102 post-cycles 1 and 2 audit, 92 post-cycle 3 'Diafrailty Champion' audit). Improvements were observed for the rates of HbA_1c assessment and deintensification in the post-interventions 1 and 2 audit, and these persisted following the introduction of 'Diafrailty Champion'. Interventions that included raising awareness of the inpatient assessment and management of people with diabetes and frailty were successful in improving inpatient HbA_1c assessment and deintensification rates. The improved HbA_1c assessment and deintensification rates persist following the engagement of a resident doctor 'Diafrailty Champion'.