JMIR Publications

ABSTRACT

Background:

Diabetes is a metabolic condition that affects approximately 11.3% of the United States population (CDC), and approximately 12.7% of the population in Texas specifically. Worse still, only 50.5% of US adults with diabetes achieve an HbA1c level of less than 7%, indicating poor glycemic control. Inpatient diabetes educators play a crucial role in providing patients with self-management education aimed at reducing complications and preventing rehospitalization. Despite its importance, little research exists on the education provided, patient enrollment criteria, and barriers faced by inpatient diabetes educators.

Objective:

Understanding how diabetes education is currently structured in inpatient settings, the challenges educators encounter, and how/if these programs follow up post-discharge is critical to improving educational interventions. Identifying gaps in inpatient diabetes education is key to improving patient outcomes, decreasing complication burden, and reducing healthcare costs. This research provides insight to guide future improvements in diabetes education and care transitions.

Methods:

A mixed-methods cross-sectional study was conducted across four hospital-based inpatient diabetes education programs. Diabetes educators completed structured surveys assessing criteria for patient inclusion, patient volume, educational content, delivery methods, resource sourcing, validation practices, follow-up protocols, and perceived barriers to education. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed thematically.

Results:

Across all four hospital systems, diabetes educators identified patients using elevated HbA1c (thresholds ranged from >6.5% to unstandardized, consult-dependent triggers), new diagnoses (75%), and new prescription of insulin (75%). Education teams consisted of registered nurses, with 75% employing Certified Diabetes Care and Education Specialists (CDCES). Daily volume varied widely (0–60 patients/day) and correlated strongly with staffing. Uncovered patients defaulted to floor nurse discharge education. Educational materials varied from commercial and association booklets to tailored packets addressing specific population barriers. Resource updates ranged from annual reviews to administrative delays exceeding three years, with no regional repository. Post-discharge phone follow-up was performed by 50% of education groups, and readmissions triggered re-education at three facilities. Commonly reported barriers across institutions included low health literacy, medication costs, scheduling and transportation conflicts for outpatient classes, paucity of outpatient education, insulin storage challenges, and limited interprofessional rounding communication.

Conclusions:

While inpatient diabetes education is available in most hospitals, we found that differences in educational content, staffing models, resource availability, and post-discharge continuity lead to varying patient knowledge across hospital tiers. Educators are limited by staff shortages and are often forced to rely on self-curated, unstandardized materials and constrained visit capacity. Standardizing hospital education protocols, establishing centralized resource repositories, and expanding dedicated educator staffing are essential to bridge these institutional divides and promote regional health equity across safety-net, community, and tertiary-quaternary systems. Future studies should evaluate patient perspectives and measure the direct impact of standardized inpatient education on post-discharge glycemic control and readmission rates.