YNHH initiates Connecticut's first full-time inpatient diabetes treatment team

Due to the growing national incidence of diabetes, American hospitals are increasingly admitting diabetic patients for a variety of other illnesses or surgeries. Until they are admitted, many of these patients aren't even aware that they have diabetes, a disease in which the body does not produce or properly use insulin. Insulin is a hormone needed to convert sugar, starches and other food into energy for daily life.

To address the needs of its growing number of diabetic patients, Yale-New Haven Hospital (YNHH) has initiated Connecticut's first full-time dedicated inpatient diabetes treatment team. The team's goals are to control a patient's blood sugar levels during hospitalization so patients heal quicker with fewer complications, and to educate them about their diabetes for a successful transition from inpatient to outpatient.

The team began serving patients in July, and represents a joint effort between YNHH and the Yale University School of Medicine. The program is headed by Silvio Inzucchi, MD, clinical director, section of endocrinology and professor of medicine. The team also includes Gael Ulisse, advanced practice registered nurse (APRN), diabetes nurse practitioner, and Helen Psarakis, APRN, diabetes nurse educator. They work extensively with physicians and nurses to improve the quality of diabetes control provided to inpatients on all medical and surgical units at YNHH. They also educate patients and staff about the disease.

Diabetes is a growing health problem in the United States, and patients at YNHH reflect this trend. In 2004, nearly 21 percent of all adult patients hospitalized at YNHH had diabetes; nationally, it is estimated that 23 percent of hospitalized adult patients have diabetes. In the past 10 years, the number of patients admitted to YNHH with diabetes has climbed by nearly 50 percent.

"We have discovered that strict glucose control accelerates patients' recovery," said Dr. Inzucchi. "By supplementing the patient's regular care team with a dedicated team of diabetes specialists, we decrease complications from surgery or other illnesses, decrease rates of infection and shorten their stay in the hospital."

In the past, maintaining strict control of blood sugar levels was not seen as an essential part of the patient's treatment. However, research has shown that maintaining optimal blood sugar levels improves patient care and recovery time. The traditional approach of controlling elevated blood sugar levels in hospitalized patients relied on intermittent use of short-acting insulin. A more aggressive approach to glucose control, using different insulin types and continuous insulin infusions, together with frequent monitoring and blood sugar readings, has the potential to be more effective in reducing the hospital length of stay, infection rates and overall mortality.

"We used to treat elevated blood sugars in patients for whom diabetes was a secondary condition not as a major problem, but as a minor one that stayed in the background," said Tom Balcezak, MD, assistant chief of staff at Yale-New Haven Hospital. "But that background problem has a major impact on the patient's primary illness and condition. This new team will provide the essential supplementary care that can help the patient's primary team develop a treatment plan to tighten control over the patient's glucose and also send that patient home with a plan to live healthfully with the disease."

Photo caption: Members of the Yale-New Haven Hospital diabetes treatment team are, left to right: Dr. Olga Sakharova, fellow, department of endocrinology; Dr. Samantha Demauro, fellow, department of endocrinology; Dr. Silvio Inzucchi, director and professor of medicine, department of endocrinology; Gael Ulisse, APRN; Dr. Susan Brian, fellow, department of endocrinology; Helen Psarakis, APRN.