Clinic bridges inpatient, outpatient diabetes care

UAB’s Diabetes Bridge Clinic helps patients keep symptoms under control during the vulnerable period as they go from hospital to home.

After diabetes destroyed his kidney function, retired restaurateur Charles Collins received a transplant last fall that saved his life — but it didn’t cure his disease. In fact, it took the Diabetes Bridge Clinic at the University of Alabama at Birmingham to help Collins get to the point where he could manage his disease and keep his new kidney healthy.

UAB’s clinic, one of the first of its kind in the nation, helps people go from the hospital to home with a continuum of diabetes care. Many times, the severity of a patient’s illness and the types of medical treatments they receive in the hospital can disrupt glucose and diabetes control. Diabetes Bridge Clinic physicians, nurses and other staff work closely with patients after they are discharged to help them regain control of their diabetes.

Collins recovered from his transplant at UAB Hospital in about a week and was ready to go home to Panama City, Fla. But he was having difficulty keeping his blood sugar regulated. “The medications I was on, prednisone and several others, had my blood sugar out of whack and it would go up and down before meals and after meals,” Collins says.

The Diabetes Bridge Clinic began working with him immediately after he was discharged and soon had his diabetes under control.

“There is a real need to improve the transition of care from the hospital to the clinic,” says Diabetes Bridge Clinic Director Fernando Ovalle, M.D., associate professor in the Division of Endocrinology, Diabetes and Metabolism and senior scientist in the UAB Comprehensive Diabetes Center. Getting a patient’s diabetes regulated after a hospitalization usually takes more than just a few days. If it’s not controlled quickly enough, complications can occur and patients can end up back in the hospital.

“We know the weeks following hospitalization are a vulnerable period. There is a lot of attention now on improving the care of diabetes or hyperglycemia because we know blood sugar control improves the outcome not only of the diabetes but also the other reason for the hospitalization. This clinic is an example of how UAB is working to improve outcomes for diabetics.”

The issue, Ovalle says, often is not the care patients receive while they are in the hospital but in the lag between the time a patient is discharged and the time they see their primary physician.

“Sometimes a patient’s primary care physician may not be able to see the patient for a week or even a month after discharge,” he says.

Patients referred to the Diabetes Bridge Clinic usually can get their diabetes under control after the second visit and they are then referred back to their primary doctor for follow up. They usually stay with the clinic for no more than a month. Patients from any hospital, not just UAB, can be referred to the clinic.

“We don’t want to take over all of their care; we just want to make sure they are doing well during that important few weeks after they leave the hospital, because it’s a critical period,” Ovalle says.

Collins says he was willing to do whatever the clinic’s doctors thought was necessary.

“We live so far away we wanted to make sure when we left we were in real good shape so we didn’t have to turn around and come back,” he says.

Ovalle calls the clinic a win-win for patients and the health-care system.

“Overall a clinic like this contributes to shorter hospital stays, saves money and leads to better outcomes: People get better sooner and with less complications,” he says.

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