Respiratory-Endocrinology Multidisciplinary Co-Management Pathway in Hospitalized Patients with ECOPD and Diabetes: A Randomized Controlled Trial.

Abstract

Exacerbation of chronic obstructive pulmonary disease (ECOPD) frequently coexists with diabetes mellitus, creating competing priorities for respiratory stabilization and safe inpatient glycemic control. Evidence for an integrated, respiratory-endocrinology co-management pathway in this population remains limited. A total of 162 inpatients hospitalized with ECOPD and comorbid diabetes between January 1 and December 31, 2025 were randomly allocated to a respiratory-endocrinology multidisciplinary co-management pathway or usual care. The intervention comprised an ECOPD care bundle, protocolized glycemic management, pulmonary rehabilitation, and a structured discharge transition package. Primary outcomes were chronic airways assessment test (CAAT) and patient-day hyperglycemia/hypoglycemia. Secondary outcomes included length of stay, 30-day readmission, functional capacity assessed by the 1-min sit-to-stand (1-min STS) test (at discharge and 30 days), patient satisfaction (CSQ-8; at discharge and 30 days), and care-transition quality measured by the Care Transitions Measure-3 (CTM-3; at 7 and 30 days). Compared with usual care, co-management yielded clinically meaningful improvements in CAAT at discharge and at 30 days. Co-management reduced hyperglycemic patient-days (rate ratio 0.799) without an increase in mild, moderate or severe hypoglycemia. The intervention group also had a shorter length of stay, a lower 30-day readmission rate, higher CSQ-8 scores, higher CTM-3 scores, and greater 1-min sit-to-stand performance at discharge and 30 days. Findings were consistent in sensitivity analyses restricted to systemic corticosteroid recipients. A structured respiratory-endocrinology multidisciplinary co-management pathway improved ECOPD-related health status and inpatient glycemic safety while enhancing functional recovery, patient experience, and short-term utilization outcomes in hospitalized patients with ECOPD and diabetes.