Background: Specialist involvement in inpatient diabetes management may enhance glycemic outcomes, but real-world evidence remains limited. This study evaluated the impact of endocrinologist involvement on glycemic control in hospitalized patients receiving insulin therapy.
Methods: We retrospectively analyzed adult inpatients with diabetes hospitalized at Seoul St. Mary’s Hospital between July 2023 and July 2024 who received insulin therapy. Patients were grouped based on whether their inpatient care involved an endocrinologist. The primary outcome was the change in hemoglobin A1c (HbA1c) between admission and the first post-discharge outpatient follow-up.
Results Among 1,099 patients, 266 (24.2%) received care involving an endocrinologist. Although the endocrinologist group had a higher baseline A1c (7.7 ± 1.9% vs. 7.3 ± 1.6%, p = 0.001), they showed greater HbA1c reduction after discharge (–0.8 ± 1.5% vs. –0.2 ± 1.6%, p < 0.001), and a lower follow-up A1c (6.9 ± 1.4% vs. 7.1 ± 1.4%, p = 0.027). Age and BMI were similar between groups. In multivariable regression adjusting for age, sex, BMI, baseline A1c, admission duration and cost, department group, and OHA use, endocrinologist involvement remained independently associated with greater A1c reduction (β = –0.260, 95% CI –0.435 to –0.086, p = 0.003).
Conclusions: Involvement of an endocrinologist in the inpatient care of patients receiving insulin was independently associated with improved glycemic outcomes. These findings support implementing structured inpatient glucose management systems led by endocrine specialists.