The Specialist Treatment Of Inpatients: Caring for Diabetes in Surgery Trial (STOIC-D Surgery) – a randomised controlled trial of early intervention with an electronic specialist-led model of diabetes care

Objective: To investigate the effect of early intervention with an electronic specialist-led ‘proactive’ model of care on glycaemic and clinical outcomes. Research Design and Methods: The STOIC-D Surgery randomised controlled trial was performed at the Royal Melbourne Hospital. Eligible participants were adults admitted to a surgical ward during the study with either known diabetes or newly-detected hyperglycaemia (at least one random blood glucose result ≥ 11.1 mmol/L). Participants were randomised 1:1 to standard diabetes care or the intervention consisting of an early consult by a specialist inpatient diabetes team utilising electronic tools for patient identification, communication of recommendations, and therapy intensification. The primary outcome was median patient-day mean glucose (PDMG). The key secondary outcome was incidence of healthcare-associated infection (HAI). Trial registration: ACTRN12620001303932. Results: Between February 12, 2021, and December 17, 2021, 1371 admissions met inclusion criteria with 680 assigned to early intervention and 691 to standard diabetes care. Baseline characteristics were similar between groups. The early intervention group achieved a lower median PDMG of 8.2 mmol/L (interquartile range [IQR] 6.9-10.0 mmol/L) compared with 8.6 mmol/L (IQR 7.2-10.3 mmol/L) in the control group for an estimated difference of -0.3 mmol/L (95% confidence interval [95%CI] -0.4 to -0.2 mmol/L, p<0.0001). The incidence of HAI was lower in the intervention group (77 [11%] vs. 110 [16%]), for an absolute risk difference of -4.6% (95%CI -8.2 to -1.0, p=0.016). Conclusions: In surgical inpatients, early diabetes management intervention with an electronic specialist-led diabetes model of care reduces glucose and HAI.