Development and implementation of a diagnostic and therapeutic care pathway for type 2 diabetes management in the hospital setting: preliminary findings from an Italian retrospective observational study.

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes and Metabolic Disorders Pub Date : 2025-10-13 eCollection Date: 2025-12-01 DOI:10.1007/s40200-025-01745-y

Michela Conti, Donatella Armata, Francesca Rubino, Laura Cuttitta, Emanuele Amodio, Alfredo Caputo, Gabriele Giannola, Alessandra Puleo, Maurizio Renda

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引用次数: 0

Abstract

Purpose: The 2022-2023 Italian diabetes guidelines emphasize individualized therapy and structured discharge planning for hospitalized patients with type 2 diabetes mellitus (T2DM). Despite the associate risks, traditional T2DM treatment regimens often include sulfonylureas and insulin. This study evaluated the impact of the Diagnostic and Therapeutic Care Pathway (PDTA) - a guideline-based program prioritizing GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i), along with structured outpatient follow-up - on glycemic control in non-critically ill hospitalized T2DM patients.

Methods: This retrospective, observational study included patients with pre-existing or newly diagnosed T2DM hospitalized in non-critical care settings due to acute events. All patients were managed under the PDTA and followed at 1, 3, 6, and 12 months post-discharge. The primary endpoint was the change in HbA1c from hospitalization. Data on prescribed T2DM treatments and hospital readmissions were collected.

Results: Among 110 patients (mean age 71.8 ± 10.1 years), 45% were hospitalized due to major adverse cardiovascular events (MACE) and 55% due to sepsis or respiratory failure. The mean HbA_1c at hospitalization was 8.7% (Interquartile Range [IQR] 7.7-9.1), which monotonically and significantly decreased to 6.6% (IQR 6.1-7.7) at 12 months (p < 0.001). The greatest decrease occurred between 6 and 12 months, coinciding with the predominant use of combined GLP-1RA and SGLT2i therapy. Insulin requirement declined over time, both in prevalence and dosage. The 12-month hospital readmission rate was 13.9%, with few cardiovascular-related events.

Conclusion: PDTA implementation resulted in sustained improvements in glycemic control among T2DM patients, supporting the broader adoption of structured, guideline-based care models.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01745-y.

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医院2型糖尿病诊断和治疗护理途径的制定和实施：意大利回顾性观察性研究的初步结果

目的：2022-2023年意大利糖尿病指南强调2型糖尿病（T2DM）住院患者的个体化治疗和结构化出院计划。尽管存在相关风险，传统的2型糖尿病治疗方案通常包括磺脲类药物和胰岛素。本研究评估了诊断和治疗护理途径（PDTA）对非危重住院T2DM患者血糖控制的影响。PDTA是一项基于指南的计划，优先考虑GLP-1受体激动剂（GLP-1RA）和SGLT2抑制剂（SGLT2i），以及结构化的门诊随访。方法：这项回顾性观察性研究纳入了因急性事件而在非重症护理机构住院的已有或新诊断的T2DM患者。所有患者在PDTA下进行管理，并在出院后1、3、6和12个月随访。主要终点是住院后HbA1c的变化。收集T2DM处方治疗和再入院的数据。结果：110例患者（平均年龄71.8±10.1岁）中，45%因严重心血管不良事件（MACE）住院，55%因败血症或呼吸衰竭住院。住院时平均HbA1c为8.7%（四分位数范围[IQR] 7.7-9.1）， 12个月时单调且显著下降至6.6% (IQR 6.1-7.7) (p结论：PDTA的实施导致T2DM患者血糖控制持续改善，支持更广泛地采用结构化、基于指南的护理模式。补充资料：在线版本提供补充资料，网址为10.1007/s40200-025-01745-y。

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来源期刊

Journal of Diabetes and Metabolic Disorders Medicine-Internal Medicine

CiteScore

4.80

自引率

3.60%

发文量

210

期刊介绍： Journal of Diabetes & Metabolic Disorders is a peer reviewed journal which publishes original clinical and translational articles and reviews in the field of endocrinology and provides a forum of debate of the highest quality on these issues. Topics of interest include, but are not limited to, diabetes, lipid disorders, metabolic disorders, osteoporosis, interdisciplinary practices in endocrinology, cardiovascular and metabolic risk, aging research, obesity, traditional medicine, pychosomatic research, behavioral medicine, ethics and evidence-based practices.As of Jan 2018 the journal is published by Springer as a hybrid journal with no article processing charges. All articles published before 2018 are available free of charge on springerlink.Unofficial 2017 2-year Impact Factor: 1.816.