Diabetes continues to affect an increasing number of people. In response to rising morbidity rates, a groundbreaking initiative launched by the diabetes team at Rambam Health Care Campus (Rambam) in Haifa, Israel, and endorsed by the Israeli Ministry of Health, has been implemented in 26 hospitals countrywide.
Approximately one-third of hospitalized patients suffer from elevated blood glucose levels caused by an underlying condition or poorly managed diabetes. Others discover they have diabetes through routine testing. Furthermore, the number of hospital staff specially trained in diabetes care remains limited despite the increasing number of patients needing their attention. Combined, these factors strain the quality of care. A Rambam-led initiative is bridging this gap.
Photo: (L-R) Dr. Irit Hochberg and Rachel Shental
“Consistently high glucose levels during hospitalization require immediate attention,” explains Rachel Shental, a clinical diabetes specialist nurse and coordinator at the Institute of Endocrinology, Diabetes & Metabolism at Rambam. “Diabetes affects morbidity and recovery, and if left untreated or poorly managed, it can lead to significant complications. Maintaining optimal levels is essential for recovery; poorly balanced sugar levels weaken the body’s ability to combat acute conditions and potentially worsen the patient’s health.”
Global studies show that following diabetes treatment protocols during hospitalization improves outcomes, shortens hospital stays, decreases infections, and reduces costs. Dr. Irit Hochberg, Director of the Institute of Endocrinology, Diabetes & Metabolism, explains, “These benefits are well-documented in cardiac surgeries, where balanced blood glucose levels reduce complications — even in patients without a prior diabetes diagnosis.”
Development, Training, and Integration
Training hospital staff in providing effective and safe diabetic care is complex and challenging.
Recognizing the need for comprehensive training across all hospital staff, Shental and Dr. Hochberg initiated a nationwide effort to improve the management of diabetes during hospitalization. In collaboration with Olga Bronstein, director of quality control at the Ministry of Health, they developed a comprehensive training program with diabetes coordinators nationwide. The goal is to establish a standardized therapeutic language and simulations of common medical scenarios, including a Rambam-developed e-learning module and mobile app to ensure continuous application of treatment principles
Within a few months, assisted by the Ministry of Health, this information was distributed and has already been integrated into 26 general hospitals.
This initiative is the first of its kind in the world and has garnered interest from the American Diabetes Association.
A Window of Opportunity
Hochberg and Shental explain that if a patient’s blood glucose levels repeatedly exceed 180 mg/dL, treatment and follow-up should begin during hospitalization. The timing offers a critical window of opportunity for patients to learn about their disease, its ramifications – a lifelong condition – and how to control it. An appropriate and precise treatment and follow-up plan is key to optimal outcomes. In the long term, diabetes management is essential for better health, and managing it after discharge helps prevent complications and readmission.
Hochberg and Shental emphasize the complexities of treating diabetes, “It requires patience. This is an important step forward, and we must continue to adapt and refine our approach to meet evolving challenges. As a healthcare system, we have the ability and responsibility to improve.”