RESUMO
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 (ageâ¯≥â¯60) with DM who had hip-fracture surgery (Nâ¯=â¯176) were recruited and randomly assigned to diabetes-specific care (nâ¯=â¯88) and usual care (nâ¯=â¯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, 24â¯months afterwards. RESULTS: Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (bâ¯=â¯5.24, pâ¯<â¯.01), peak-force quadriceps strength of the affected limb (bâ¯=â¯2.13, pâ¯<â¯.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 (bâ¯=â¯11.35, pâ¯<â¯.05), and frequency-domain parameters, such as low frequency (bâ¯=â¯42.17, pâ¯<â¯.05), and the high frequency-to-low frequency ratio (bâ¯=â¯0.11, pâ¯<â¯.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 24â¯months following hospital discharge, above and beyond the effects of usual care.