SAT-859 - Education That Lasts: Inpatient Diabetes Educators and Sustained HbA1c Reduction in A Two-Institution Real-World Cohort

Background:
Uncontrolled diabetes mellitus remains a major contributor to hospital admissions and long-term complications. While lifestyle counseling, nutrition education, and treatment adherence are central to diabetes management, structured inpatient diabetes education is inconsistently implemented and frequently overlooked during hospitalization. Evidence demonstrating its sustained impact on post-discharge glycemic control in real-world hospitalized populations is limited. We evaluated the association between inpatient diabetes educator referral and longitudinal changes in HbA1c among patients with poorly controlled diabetes.

Methods:
We conducted a retrospective observational study using electronic medical record data from two tertiary care institutions between January 2023 and August 2025. Adult inpatients (≥18 years) with type 1 diabetes, type 2 diabetes, or newly diagnosed diabetes and an admission HbA1c >7.5% were eligible. Inclusion required documented inpatient diabetes education and a repeat HbA1c measured at least 3 months following the index hospitalization. Exclusion criteria included palliative or hospice care, inability to complete follow-up, and discharge to skilled nursing facilities. Of 717 patients meeting initial eligibility, 329 had paired HbA1c data and were included in the final analysis. Baseline and follow-up HbA1c values were compared using paired statistical methods.

Results:
Among the 329 included patients, inpatient diabetes education was associated with a significant and clinically meaningful improvement in glycemic control. Mean HbA1c decreased by 1.65 percentage points from baseline (95% CI: −1.98 to −1.33; p = 1.44 × 10⁻²⁰). Although individual patient responses varied, the overall reduction was consistent and sustained beyond hospitalization.

Conclusions:
Inpatient diabetes education led to significant and sustained HbA1c reductions in hospitalized patients with uncontrolled diabetes. Each institution should have in-house diabetes educators, with all patients with elevated HbA1c automatically referred on day 1 of admission, making this a low-cost, scalable, and highly effective strategy to improve long-term glycemic outcomes.

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