Background: Specialist involvement is thought to improve inpatient glycemic management, yet evidence from real-world clinical settings remains limited. This study aimed to evaluate whether endocrinologist consultation during hospitalization for diabetes requiring insulin therapy is associated with better post-discharge glycemic control.
Methods: We conducted a retrospective cohort study including adult patients with diabetes hospitalized at Seoul St. Mary’s Hospital between July 2023 and July 2024 who were treated with insulin. Patients were classified according to whether an endocrinologist was involved in their inpatient management. The primary outcome was the change in hemoglobin A1c (HbA1c) from admission to the first outpatient follow-up visit after discharge. Secondary outcomes included length of hospital stay, readmission rates within 30 days, and in-hospital mortality. Multivariable linear regression analyses were performed adjusting for age, sex, body mass index (BMI), baseline A1c, hospital stay duration, hospitalization costs, department of admission, and oral hypoglycemic agent use.
Results: Of 1,099 patients analyzed (mean age 64.5 years; 61.0% male), 266 (24.2%) received care involving an endocrinologist. The endocrinologist group had significantly higher baseline HbA1c (7.7 ± 1.9% vs. 7.3 ± 1.6%, p=0.001) but achieved a greater reduction in HbA1c after discharge (–0.8 ± 1.5% vs. –0.2 ± 1.6%, p<0.001) and lower follow-up HbA1c (6.9 ± 1.4% vs. 7.1 ± 1.4%, p=0.027). In adjusted analyses, endocrinologist involvement remained independently associated with greater HbA1c reduction (β=–0.260, 95% CI –0.435 to –0.086, p=0.003). No significant differences were observed in in-hospital mortality or 30-day readmission rates between the two groups.
Conclusions: Endocrinologist consultation during hospitalization for patients requiring insulin therapy was independently associated with significant improvement in glycemic control after discharge, underscoring the value of structured inpatient diabetes care involving endocrine specialists.