Beyond Hospital Readmissions: A Multifaceted Insulin-Centered Diabetes Education Approach Impacts Contemporary Acute Care Outcomes and Prolongs Home Time

OBJECTIVES Diabetes transition of care (TOC) education needs novel approaches to decrease post-hospitalization acute care. Insulin use is a strong and modifiable predictor of acute care utilization. Using a quasi-experimental study design, we aimed to evaluate the effects of a multifaceted approach with a post-discharge insulin-centered TOC component (PD-ITOC) on all-cause and diabetes-related acute care visits (ACV), including inpatient returns and the seldom reported outcomes of hospital observation (H-OBS), emergency room visits (ER-V), and non-ACV home time. METHODS Adults with diabetes leaving a teaching hospital on insulin between 2017 and 2024 received inpatient insulin self-adjustment and self-titration (ISAST) skill education. PD-ITOC continued ISAST education through at-home phone visits. Odds of 30-day ACV with PD-ITOC and post-discharge usual care (PD-UC) were compared using logistic regression after propensity score weighting balanced baseline between-group differences. Survival analysis examined non-ACV home time. RESULTS Among 1217 patients (PD-ITOC: n=970; PD-UC: n=247), PD-ITOC was associated with lower odds of all-cause (OR 0.37, 95% CI 0.25-0.55) and diabetes-related (OR 0.30, 95% CI 0.14-0.66) hospital returns, including H-OBS, and reduced the odds of all-cause and diabetes-related ER-V (OR 0.53; 95% CI 0.36-0.77, and 0.50; 95% CI 0.25- 0.99, respectively). PD-ITOC had longer non-ACV home time than PD-UC (p<0.0001). CONCLUSIONS A multifaceted approach targeting insulin use through individualized ISAST education, initiated inpatient and continued at home through phone visits, significantly reduced 30-day all-cause and diabetes-related ACV, including ER-V, H-OBS and inpatient returns, while increasing non-ACV home time, when compared to inpatient-only ISAST education and post-discharge usual care.