Saturday, February 21, 2015

Admission HgbA1C to help determine discharge diabetes regimen

From a study in Diabetes Care:

RESEARCH DESIGN AND METHODS This was a prospective, multicenter open-label study aimed to determine the safety and efficacy of a hospital discharge algorithm based on admission HbA1c. Patients with HbA1c less than 7% (53.0 mmol/mol) were discharged on their preadmission diabetes therapy, HbA1c between 7 and 9% (53.0–74.9 mmol/mol) were discharged on a preadmission regimen plus glargine at 50% of hospital daily dose, and HbA1c greater than 9% were discharged on oral antidiabetes agents (OADs) plus glargine or basal bolus regimen at 80% of inpatient dose. The primary outcome was HbA1c concentration at 12 weeks after hospital discharge.

RESULTS A total of 224 patients were discharged on OAD (36%), combination of OAD and glargine (27%), basal bolus (24%), glargine alone (9%), and diet (4%). The admission HbA1c was 8.7 ± 2.5% (71.6 mmol/mol) and decreased to 7.3 ± 1.5% (56 mmol/mol) at 12 weeks of follow-up (P less than 0.001). The change of HbA1c from baseline at 12 weeks after discharge was −0.1 ± 0.6, −0.8 ± 1.0, and −3.2 ± 2.4 in patients with HbA1c less than 7%, 7–9%, and greater than 9%, respectively (P less than 0.001). Hypoglycemia (less than 70 mg/dL) was reported in 22% of patients discharged on OAD only, 30% on OAD plus glargine, 44% on basal bolus, and 25% on glargine alone and was similar in patients with admission HbA1c less than or equal to 7% (26%) compared with those with HbA1c greater than

CONCLUSIONS Measurement of HbA1c on admission is beneficial in tailoring treatment regimens at discharge in general medicine and surgery patients with type 2 diabetes.

From commentary in the ACP Hospitalist Weekly:

Measuring HbA1c at admission can help with tailoring a postdischarge treatment regimen for type 2 diabetes patients, the study authors concluded. The observed rate of hypoglycemia was acceptable, which should reassure any hospital clinicians who avoid intensifying outpatient regimens out of fear of hypoglycemia, the authors noted. The findings also support recent guidelines recommending insulin treatment during hospitalization, but resumption of oral medications at discharge for patients with acceptable control. Improving postdischarge glucose control could potentially reduce revisits to the emergency department or hospital, the authors suggested.
Measuring HbA1c at admission can help with tailoring a postdischarge treatment regimen for type 2 diabetes patients, the study authors concluded. The observed rate of hypoglycemia was acceptable, which should reassure any hospital clinicians who avoid intensifying outpatient regimens out of fear of hypoglycemia, the authors noted. The findings also support recent guidelines recommending insulin treatment during hospitalization, but resumption of oral medications at discharge for patients with acceptable control. Improving postdischarge glucose control could potentially reduce revisits to the emergency department or hospital, the authors suggested.

It's important to note that patients in the study had telephone contacts every 2 weeks in the 2 months after discharge and follow-up visits at 1 and 3 months, which could have contributed to their improved glycemic control.
It's important to note that patients in the study had telephone contacts every 2 weeks in the 2 months after discharge and follow-up visits at 1 and 3 months, which could have contributed to their improved glycemic control.

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