Development and implementation of a diagnostic and therapeutic care pathway for type 2 diabetes management in the hospital setting: preliminary findings from an Italian retrospective observational study

Purpose: The 2022–2023 Italian diabetes guidelines emphasize individualized therapy and structured discharge planning for hospitalized patients with type 2 diabetes mellitus (T2DM). Despite the associate risks, traditional T2DM treatment regimens often include sulfonylureas and insulin. This study evaluated the impact of the Diagnostic and Therapeutic Care Pathway (PDTA) - a guideline-based program prioritizing GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i), along with structured outpatient follow-up - on glycemic control in non-critically ill hospitalized T2DM patients. Methods: This retrospective, observational study included patients with pre-existing or newly diagnosed T2DM hospitalized in non-critical care settings due to acute events. All patients were managed under the PDTA and followed at 1, 3, 6, and 12 months post-discharge. The primary endpoint was the change in HbA1c from hospitalization. Data on prescribed T2DM treatments and hospital readmissions were collected. Results: Among 110 patients (mean age 71.8 ± 10.1 years), 45% were hospitalized due to major adverse cardiovascular events (MACE) and 55% due to sepsis or respiratory failure. The mean HbA1c at hospitalization was 8.7% (Interquartile Range [IQR] 7.7–9.1), which monotonically and significantly decreased to 6.6% (IQR 6.1–7.7) at 12 months (p < 0.001). The greatest decrease occurred between 6 and 12 months, coinciding with the predominant use of combined GLP-1RA and SGLT2i therapy. Insulin requirement declined over time, both in prevalence and dosage. The 12-month hospital readmission rate was 13.9%, with few cardiovascular-related events. Conclusion: PDTA implementation resulted in sustained improvements in glycemic control among T2DM patients, supporting the broader adoption of structured, guideline-based care models.