Follow-up of STOIC-D Surgery RCT - Supplementary Materials

This is the supplementary material for the research report titled: "Early electronic specialist-led diabetes care improves post-discharge glycaemia: the STOIC-D Surgery follow-up cohort. ". The abstract of the research is as below:Objective: To assess the effect of an early, electronic specialist-led model of inpatient diabetes care on glycaemic outcomes following discharge and rates of treatment intensification. Methods: The STOIC-D trial has demonstrated early, electronic specialist-led care by an inpatient diabetes service reduces inpatient hyperglycaemia. This follow-up study assessed glycaemic outcomes following discharge in a subgroup of 360 STOIC-D trial patients with admission HbA1c ≥ 7% and alive 1 year following hospitalisation. First available HbA1c between 3-15 months following discharge was collected. Multivariable logistic regression identified predictors of clinically significant reduction in HbA1c, defined as ≥ 0.5%. Multivariable linear regression assessed correlation of baseline characteristics with change in HbA1c. Multivariable logistic regression identified predictors of treatment intensification in hospital. Results: The early intervention arm experienced a greater HbA1c reduction following hospitalisation [0.4% (3.9mmol/mol) vs -0.04% (-0.4mmol/mol)] compared with pre-admission (p = 0.02). Clinically significant reduction in HbA1c occurred more frequently in the intervention arm [45% vs 31%, (p = 0.01), adjusted odds ratio (aOR) 1.8 (95% confidence interval (CI):1.1-2.9)]. Adjusted multivariable linear regression demonstrated inclusion in the intervention arm correlated with proportional reduction in post-hospitalisation HbA1c. Treatment intensification was more common in the intervention compared with control [36% vs 19%, (p = 0.002), aOR 2.2 (95% CI: 1.3-3.6)]. In a sub-analysis of participants with admission HbA1c 7-8.5%, age <75 years, the aOR for treatment intensification with early intervention was 4.0 (95% CI: 1.6-11.1). Conclusions: Treatment intensification and post hospitalisation HbA1c improved following intervention with an early, electronic specialist-led consultation in hospital.

本内容为题为《早期专科医师主导的电子化糖尿病护理可改善出院后血糖控制：STOIC-D手术随访队列》的研究报告的补充材料。该研究的摘要如下：
目的：评估早期、专科医师主导的电子化住院糖尿病护理模式对患者出院后血糖结局（glycaemic outcomes）及治疗强化（treatment intensification）率的影响。
方法：STOIC-D试验已证实，由住院糖尿病诊疗团队提供的早期电子化专科护理可降低住院期间高血糖发生率。本随访研究针对STOIC-D试验中的360名亚组患者展开，纳入标准为入院时糖化血红蛋白（HbA1c）≥7%且出院后存活满1年。收集患者出院后3~15个月内首次测得的HbA1c数据。采用多变量logistic回归（multivariable logistic regression）分析HbA1c较基线降低≥0.5%这一具有临床意义的改善的预测因素；采用多变量线性回归（multivariable linear regression）分析基线特征与HbA1c变化量的相关性；采用多变量logistic回归（multivariable logistic regression）识别住院期间治疗强化的预测因素。
结果：与入院前相比，早期干预组患者出院后的HbA1c降幅更显著[0.4%（3.9mmol/mol） vs -0.04%（-0.4mmol/mol）]（P=0.02）。干预组中HbA1c出现具有临床意义的降低的患者占比更高[45% vs 31%，P=0.01，校正后优势比（adjusted odds ratio, aOR）1.8，95%置信区间（confidence interval, CI）：1.1~2.9]。校正后的多变量线性回归分析显示，被分配至干预组与出院后HbA1c的比例降幅显著相关。干预组的治疗强化率高于对照组[36% vs 19%，P=0.002，aOR 2.2，95%CI：1.3~3.6]。在入院HbA1c为7%~8.5%且年龄<75岁的亚组分析中，早期干预带来的治疗强化aOR为4.0（95%CI：1.6~11.1）。
结论：院内早期电子化专科医师会诊干预可提升患者的治疗强化率，并改善出院后的HbA1c控制水平。