Foundations and evidence

Abstract

The Diabetes Day Hospital (DDH) constitutes an intermediate outpatient care model between conventional hospitalization and outpatient consultation, designed to provide specialized non-deferrable care to people with diabetes in situations of special clinical complexity. The implementation of DDH in Argentina responds to the need to optimize healthcare resources, reduce unnecessary hospitalizations, and improve the quality of life of diabetic patients.

The consensus document by the Spanish Diabetes Society (SED) and the Spanish Society of Endocrinology and Nutrition (SEEN) establishes that DDH significantly reduces hospital admission rates due to acute decompensations (35-53% according to various studies), decreases emergency department visits, and improves structured therapeutic education. The American Diabetes Association (ADA) 2026 Standards support comprehensive outpatient care models with rapid access (<24 hours ideally) for situations such as type 1 diabetes onset, hyperglycemic decompensations, gestational diabetes, and initiation of complex therapies.

Successful DDH implementation requires: (1) clear definition of services and inclusion/exclusion criteria; (2) adequate human resources management (endocrinologist 50-100% FTE, diabetes nurse educator 100% FTE, multidisciplinary team); (3) standardization of care processes adapted to local referral sources; (4) appropriate infrastructure (consultation rooms, treatment areas, diagnostic equipment); (5) integrated technology (electronic medical records, telemedicine, continuous glucose monitoring). Flexibility to adapt the model to specific needs and resources of each territory is fundamental to ensure sustainability.

Pediatric, obstetric, and diabetic foot experiences in Argentina demonstrate the versatility of the DDH model. In pediatrics, it allows type 1 diabetes onset management without prolonged hospitalization. In obstetrics, it facilitates the management of gestational and pregestational diabetes with rapid insulin therapy initiation/adjustment. In diabetic foot care, it enables complex wound care and preventive education in an outpatient setting. Educational projects developed in day hospital format (workshops in gestational diabetes, gamification in pediatric population, health team training) demonstrate the feasibility of participatory methodologies adapted to different populations.

The DDH constitutes an efficient and cost-effective strategy that improves quality of care, optimizes healthcare system financial resources, and guarantees agile, close, and safe clinical care. The federal vision of Argentine experiences demonstrates that its success lies in the capacity to adapt to local realities, interdisciplinary work, and institutional commitment.