Respiratory-Endocrinology Multidisciplinary Co-Management Pathway in Hospitalized Patients with ECOPD and Diabetes:...

Exacerbation of chronic obstructive pulmonary disease (ECOPD) frequently coexists with diabetes mellitus, creating competing priorities for respiratory stabilization and safe inpatient glycemic control. Evidence for an integrated, respiratory-endocrinology co-management pathway in this population remains limited. A total of 162 inpatients hospitalized with ECOPD and comorbid diabetes between January 1 and December 31, 2025 were randomly allocated to a respiratory-endocrinology multidisciplinary co-management pathway or usual care. The intervention comprised an ECOPD care bundle, protocolized glycemic management, pulmonary rehabilitation, and a structured discharge transition package. Primary outcomes were chronic airways assessment test (CAAT) and patient-day hyperglycemia/hypoglycemia. Secondary outcomes included length of stay, 30-day readmission, functional capacity assessed by the 1-min sit-to-stand (1-min STS) test (at discharge and 30 days), patient satisfaction (CSQ-8; at discharge and 30 days), and care-transition quality measured by the Care Transitions Measure-3 (CTM-3; at 7 and 30 days). Compared with usual care, co-management yielded clinically meaningful improvements in CAAT at discharge and at 30 days. Co-management reduced hyperglycemic patient-days (rate ratio 0.799) without an increase in mild, moderate or severe hypoglycemia. The intervention group also had a shorter length of stay, a lower 30-day readmission rate, higher CSQ-8 scores, higher CTM-3 scores, and greater 1-min sit-to-stand performance at discharge and 30 days. Findings were consistent in sensitivity analyses restricted to systemic corticosteroid recipients. A structured respiratory-endocrinology multidisciplinary co-management pathway improved ECOPD-related health status and inpatient glycemic safety while enhancing functional recovery, patient experience, and short-term utilization outcomes in hospitalized patients with ECOPD and diabetes.