Impact of Diabetes Teams on Health Outcomes of Patients Admitted in Hospitals in South Western Sydney

INTERVENTION: Following randomisation, half of the wards (Intervention wards) will receive the Inpatient Diabetes Team (IPDT) model of care over a 24 week period. The model of care on the selected wards will involve a diabetes nurse educator (DNE) visiting the intervention wards every day (on weekdays). Blood glucose will be measured and monitored on the wards as part of routine care by the ward staff. Based on the assessment of the DNE, inpatients with DM will be stratified into 3 groups‐ • low risk patients (BGL within 5‐10, not insulin treated) ‐ no further action • intermediate risk patients (some BGL outside of 5‐10 in past 24hr, hypos or on insulin therapy) ‐ DNE reviews patient. Referral to endocrinologist or dietitian if considered required • high risk patients (above 50% of BGL outside 5‐10, BGL >15 or severe hypoglycaemia <3.0mmol/L) ‐ DNE reviews patient AND referral to endocrinologist. Referral to dietitian if considered required The trial investigators will meet at least once a month with the diabetes nurse educators to ensure the trial protocol is being followed. CONDITION: Diabetes PRIMARY OUTCOME: Change in number of ‘good diabetes days’ during stay in hospital. ; ‘Good diabetes days’ are defined as days with no blood glucose readings <4.0 and one or less readings >10.0, as a proportion of seven days in hospital. SECONDARY OUTCOME: Change in length of stay in hospital. ; This data will be collected by linking into hospital admission and discharge records. Errors in relation to diabetes medication administration. ; This data will be collected by a research assistant from the hospital medical records based on an pre‐agreed proforma. Evidence of hypoglycaemia or severe hypoglycaemia based upon glucose monitoring. ; This data will be collected by a research assistant from the hospital medical records based on an pre‐agreed proforma. Evidence of severe or persistent hyperglycaemia based upon glucose monitoring. ; This data will be collected by a research assistant from the hospital medical records based on an pre‐agreed proforma. Readmission rate within 12 weeks. ; This data will be collected by linking into hospital admission and discharge records. INCLUSION CRITERIA: ALL patients admitted on the trial wards will be included in the study, unless they meet the exclusion criteria.