Early Electronic Specialist-led Diabetes Care Improves Postdischarge Glycemia: The STOIC-D Surgery Follow-up Cohort
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Date
2026
Source Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
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Oxford University Press
Melbourne Authors
Affiliation
Sir Peter MacCallum Department of Oncology
Medical Education
Melbourne Medical School
Medical Education
Melbourne Medical School
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Journal Article
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Citation
Gamage, I. L., Barmanray, R. D., Kyi, M., Colman, P. G., Sun, E., Le, M. V., Worth, L. J. & Fourlanos, S. (2026). Early Electronic Specialist-led Diabetes Care Improves Postdischarge Glycemia: The STOIC-D Surgery Follow-up Cohort. Journal of Clinical Endocrinology and Metabolism (JCEM), 111 (2), pp.e375-e381. https://doi.org/10.1210/clinem/dgaf440.
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Description
Abstract
Objective
To assess the effect of an early, electronic specialist-led model of inpatient diabetes care on glycemic 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 hyperglycemia. This follow-up study assessed glycemic outcomes following discharge in a subgroup of 360 STOIC-D trial patients with admission glycated hemoglobin (HbA1c) ≥ 7% and alive 1 year following hospitalization. First available HbA1c between 3 and 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 hospitalization (0.4% [3.9 mmol/mol] vs -0.04% [-0.4 mmol/mol]) compared with preadmission (P = .02). Clinically significant reduction in HbA1c occurred more frequently in the intervention arm (45% vs 31% [P = .01], adjusted odds ratio [aOR] 1.8; 95% CI, 1.1-2.9). Adjusted multivariable linear regression demonstrated inclusion in the intervention arm correlated with proportional reduction in posthospitalization HbA1c. Treatment intensification was more common in the intervention compared with control (36% vs 19% [P = .002], aOR 2.2 [95% CI: 1.3-3.6]). In a subanalysis of participants with admission HbA1c of 7% to 8.5%, age <75 years, the aOR for treatment intensification with early intervention was 4.0 (95% CI, 1.6-11.1).
Conclusion
Treatment intensification and posthospitalization HbA1c improved following intervention with an early, electronic specialist-led consultation in hospital.