Abstract
Background: Diabetes discharge education is essential for post-stroke care in patients with comorbid diabetes, as it supports self-management and may reduce complications and readmissions. However, its delivery remains inconsistent, and the factors influencing its provision are not well understood. We investigated the frequency and associated factors of diabetes discharge education among diabetic adults hospitalized with stroke in the Florida Stroke Registry (FSR).
Methods: We analyzed data from 34,361 adults hospitalized with ischemic stroke or intracerebral hemorrhage in FSR-participating hospitals (2019-2024), discharged to home or inpatient rehabilitation, with either a prior or newly diagnosed diabetes diagnosis. Diabetes discharge education encompasses provider-led instructions regarding medication use, lifestyle guidance, and glucose management. Mixed-effects multinomial logistic regression was used to assess mutually adjusted associations between patient-level characteristics and provision of diabetes discharge education (categorized as yes, no, or not documented), accounting for hospital-level clustering.
Results: The mean age was 68 years; 56% were male; 94% had ischemic stroke. Only 4% were newly diagnosed with diabetes at admission. Overall, 54% received diabetes discharge education. Among the 76% of patients with documented hyper- or hypoglycemia at admission in the sample, 57% received education, 20% did not, and 23% lacked documentation. Patients with a prior diabetes diagnosis were significantly less likely to receive discharge education compared to those newly diagnosed (aOR 0.49; 95% CI 0.41-0.60). Compared to privately insured patients, those with Medicare (aOR 0.92; 95% CI 0.84-1.00) and Medicaid (aOR 0.81; 95% CI 0.71-0.93) were also less likely to receive education.
Conclusion: Nearly half of stroke patients with diabetes either did not receive or lacked documentation of diabetes discharge education. Those with a prior diabetes diagnosis and those insured through Medicare or Medicaid were significantly less likely to receive education, highlighting critical gaps in care. These populations may benefit from targeted strategies to strengthen discharge education and self-management support. Future work should investigate institutional and provider-level barriers and evaluate the impact of education on reducing readmissions and improving post-stroke outcomes.