Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial

Ming Yueh Tseng, Jersey Liang, Jong Shyan Wang, Ching Tzu Yang, Chi Chuan Wu, Huey Shinn Cheng, Ching Yen Chen, Yueh E. Lin, Woan Shyuan Wang, Yea Ing L. Shyu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

8 Scopus citations

Abstract

Objectives: To examine the effects of a diabetes-specific care model for hip fractured elderly with diabetes mellitus (DM). Methods: A randomized controlled trial was implemented in a 3000-bed medical center in northern Taiwan. Older adults (age ≥ 60) with DM who had hip-fracture surgery (N = 176) were recruited and randomly assigned to diabetes-specific care (n = 88) and usual care (n = 88). Usual care entailed one or two in-hospital rehabilitation sessions. Diabetes-specific care comprised an interdisciplinary care (including geriatric consultation, discharge planning, and in-home rehabilitation) and diabetes-specific care (including dietary and diabetes education, blood pressure control, dyslipidemia management, a glycemic treatment regimen, and rehabilitation exercises). Outcomes including heart rate variability; rehabilitation outcomes; activities of daily living and instrumental activities of daily living were assessed before discharge and 1, 3, 6, 12, 18, 24 months afterwards. Results: Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (b = 5.24, p <.01), peak-force quadriceps strength of the affected limb (b = 2.13, p <.05), higher total heart rate variability in terms of the time-domain parameter for the mean squared difference between two adjacent normal R–R intervals (b = 11.35, p <.05), and frequency-domain parameters, such as low frequency (b = 42.17, p <.05), and the high frequency-to-low frequency ratio (b = 0.11, p <.01). Conclusions: Our diabetes-specific care model enhanced hip-flexion range of motion, peak quadriceps strength of the affected limb, and overall heart rate variability, indicating dynamic responses to environmental changes during the 24 months following hospital discharge, above and beyond the effects of usual care.

Original languageEnglish
Article number110689
JournalExperimental Gerontology
Volume126
DOIs
StatePublished - 15 10 2019

Bibliographical note

Publisher Copyright:
© 2019

Keywords

  • Aged
  • Diabetes mellitus
  • Heart rate variability
  • Hip fractures
  • Patient discharge

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