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Randomized Controlled Trial
. 2014 Nov;37(11):2934-9.
doi: 10.2337/dc14-0479. Epub 2014 Aug 28.

Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes

Guillermo E Umpierrez  1 , David Reyes  2 , Dawn Smiley  2 , Kathie Hermayer  3 , Amna Khan  4 , Darin E Olson  5 , Francisco Pasquel  2 , Sol Jacobs  2 , Christopher Newton  2 , Limin Peng  6 , Vivian Fonseca  4
Affiliations
Randomized Controlled Trial

Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes

Guillermo E Umpierrez et al. Diabetes Care. 2014 Nov.

Abstract

Objective: Effective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes.

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 <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 >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 < 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 <7%, 7-9%, and >9%, respectively (P < 0.001). Hypoglycemia (<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 ≤7% (26%) compared with those with HbA1c >7% (31%, P = 0.54).

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

Trial registration: ClinicalTrials.gov NCT00979628.

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Figures

Figure 1
Figure 1
Change in HbA1c concentration at 4 weeks and 12 weeks after hospital discharge.
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References

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