Abstract Body: Background: Research suggests that the absolute number of strokes among people with diabetes is increasing as the population with diabetes grows. Stroke patients with poorly controlled diabetes are more likely to experience poor functional recovery, longer recovery times, recurrent stroke, and higher risk of death. In response to a finding from the 2021 Joint Commission survey for not addressing an HbA1c=9.3, we launched a quality improvement project to enhance diabetic management among patients admitted for ischemic stroke.
Methods: This interdisciplinary collaboration involved endocrinology, hospital medicine, and neurology. For patients admitted to our Thrombectomy-Capable Stroke Center for ischemic stroke with an HbA1c ≥ 9.0% or blood glucose glucoses≥250mg/dl, a mandatory inpatient endocrine consult would be provided, in addition to diabetic educator consult. The patient’s HbA1c levels were followed every 3 months for a year.
Results: A total of 66 patients were admitted in 2022 (n=32) and 2023 (n= 34) for ischemic stroke with HbA1c ≥ 9.0%. The median HbA1C for 2022 cohort dropped from 11.2% (range 9.0% – 16.6%) to 8.5% (range 5.0% - 14.1%) in a year (p<0.05); and 10.3% (range 9.0% - 14.6%) to 7.75% (range 6.0% - 11.7%) in a year (p<0.05). 2024 data showed similar improvement with drop of HbA1c from 10.55% to 9.75% at 3 months and 9.45% at 6 months.
Conclusion: Inpatient endocrinology involvement for high-risk stroke patients with previously uncontrolled diabetes improves diabetic control over time. Endocrinologists can offer personalized treatment plans considering various factors such as comorbid conditions, patient lifestyle, and specific diabetes complications. This single center intervention is congruent with published data showing that patients under specialist care often experience HbA1c reductions of 0.5% to 1.0% or more compared to those managed by general practitioners. In high risk and high complexity cases, this improvement may potentially lead to reduced risk of stroke recurrence and complications. We postulate that this improvement is attributed to the endocrinologist’s expertise in complex diabetes management, advanced treatment options, personalized care approaches, and resources in post-discharge management. If confirmed in a multicenter clinical study, it can become a generalizable approach to improve the quality of care and outcomes of high-risk stroke patients.