A Comparative Analysis of Inpatient Versus Outpatient Management for Severely Uncontrolled Type 2 Diabetes

Abstract

Background: The global burden of diabetes continues to rise, driven by increasing prevalence, high complication rates, and substantial healthcare costs. While hospitalization is essential for acute metabolic emergencies, a considerable “grey zone” population presents with severe hyperglycemia without overt crisis, for whom the optimal care setting remains uncertain. We aimed to evaluate the clinical rationale and system-level implications of inpatient versus intensive outpatient management strategies in patients with uncontrolled diabetes.Methods: In this retrospective, single-center study, we included all adult patients for a duration of 1 year with uncontrolled diabetes who met the hospitalization criteria as recommended by clinical guidelines and personalized clinical decision-making. The patients were grouped based on whether they accepted or refused hospitalization. Both groups were treated according to the most recent guidelines, and the outcomes after six-month follow-up of admitted patients were compared to those who were treated in an outpatient setting.Results: Patients were divided into outpatient (n=72) and inpatient (n=37) groups. Groups were comparable in terms of age, gender, and comorbidities with the exception of diabetic neuropathy, which was more prevalent among inpatients. Neither the percent reduction nor the absolute difference in HbA1c levels over the follow-up period differed significantly between groups. Conclusion: In our cohort of patients with uncontrolled diabetes, there was no statistical difference in outcomes between outpatient and inpatient groups. Given the lack of added benefit from inpatient care, future strategies should focus on optimizing outpatient monitoring and intervention programs to enhance adherence and achieve better long-term glycemic control.