dromlakhani Use diabetes care and education specialists as a resource to train other staff when availability limited
STEP 1 — Gather Information
Assess DCES staffing levels, confirm patient has diabetes and is hospitalized for noncritical illness, identify potential trainer staff (nurses, pharmacists, dietitians), and screen patients for high‑risk characteristics (prior readmission, diabetes‑related admission, new diabetes diagnosis, or insulin initiation).
Action: If DCES is unavailable or limited, proceed to step 2.
STEP 2 — Rule In / Rule Out
Determine whether the patient meets criteria for inpatient diabetes education: adult with diabetes admitted for noncritical illness.
Rule in: Yes → proceed to step 3.
Rule out: No diabetes or critical illness → do not provide inpatient diabetes education per guideline.
STEP 3 — Classify or Stratify
Stratify patients by priority for education when DCES is scarce: highest priority for those at high risk for readmission, admitted for diabetes‑related issues, newly diagnosed with diabetes, or newly starting insulin.
Action: Focus training efforts on staff who will educate these prioritized patient groups.
STEP 4 — Decide
Deploy the DCES to train the identified healthcare providers on core diabetes survival skills (medication administration, BG monitoring, hypoglycemia recognition, sick‑day planning). The trained staff then deliver education to prioritized patients before discharge; if DCES becomes available, the DCES provides education directly.
Action: Implement train‑the‑trainer model and document staff competency.
Clinical Guardrails / Mimics / Pitfalls
Do not allow untrained staff to deliver education without DCES oversight; do not omit education for high‑risk patients due to staffing shortages; avoid using non‑certified personnel as sole educators without documented training; do not delay diabetes education until after discharge.
Concrete Clinical Example
A 68‑year‑old with type 2 diabetes admitted for community‑acquired pneumonia (noncritical illness) finds the DCES covering two units unavailable due to sick leave. The DCES conducts a 30‑minute train‑the‑trainer session for the floor nurse and pharmacist covering insulin administration, BG checking, hypoglycemia treatment, and sick‑day rules. The nurse provides bedside education to the patient prior to discharge, emphasizing medication timing and glucose targets, and arranges an outpatient DSMES referral. The patient is discharged safely with reduced readmission risk.
Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278