Abstract
ObjectiveTo determine the impact of diabetes-specific recommendations at 1 year after hospital discharge on glycemic control and diabetes care in an outpatient setting. MethodsA total of 139 patients with type 2 diabetes on a basal-bolus insulin regimen during hospitalization were included in the statistical analysis. We gathered data on treatment regimens after 12 to 16, 26 to 30, and 52 to 56 weeks following discharge as well as glycosylated hemoglobin (HbA1c) levels for all patients. Prescriptions for diabetes therapy were retrieved. All changes in insulin or oral/noninsulin injectable drug regimens were recorded. ResultsHalf of the patients (n = 69) were discharged on their preadmission regimen (no change), and a change in the home treatment was recommended in the other half (n = 70). In the group of patients whose preadmission therapy was adjusted, HbA1c decreased from 9.6% (80 mmol/mol) to 8.5% (69 mmol/mol) (P = .0004) 1 year after discharge. In the group of patients discharged on their preadmission regimen, no significant changes in HbA1c levels during the study were observed.At follow-ups occurring 12 to 16 weeks after discharge, 52% (95% CI: 37.4%-66.3%) of patients in the change group had their treatment modified, compared with 18.6% (95% CI: 9.7%-30.9%) in the no-change group. In the group of patients discharged on their preadmission regimen, no significant change was observed. At the beginning of the study, patients in the change treatment group had higher HbA1c levels than patients in the no-change group (9.6 ± 2.0 vs 8.6 ± 1.7, P < .001). At the end of the study, no significant changes in terms of HbA1c levels were found between the groups (8.8 ± 1.9 vs 8.5 ± 1.9, P = .2). ConclusionsSignificant improvement in diabetes control occurred 1 year after hospital discharge in patients who underwent modifications in their treatment. This supports the relevance of providing and implementing proper care recommendations at transition.
Highlights
Diabetes is a frequent comorbid condition in several hospital admissions
No significant difference in home treatment was found in the 2 groups, more patients in the group with recommendations to change their therapy had not received any antidiabetic treatment before admission (10.1% vs 1.5%, respectively), and more patients in the no recommendation for change group were treated with oral and insulin regimens (42% vs. 29%)
Our study was conducted to assess the impact of recommendations for the treatment of diabetes at hospital discharge on subsequent diabetes treatment throughout 1 year following discharge in an outpatient setting
Summary
Diabetes is a frequent comorbid condition in several hospital admissions. Multiple hospitalizations are common among patients with diabetes. During a 1-year period, these patients accounted for the majority of the hospitalizations and inpatient costs for patients with diabetes.[1]. A recent study revealed that using discharge algorithms for patients with type 2 diabetes mellitus (T2DM) improved HbA1c levels by 1.5 % (7 mmol/mol) after 12 weeks of treatment.[4] In our study, we evaluated diabetes control in 2 groups of patients for up to 12 months after discharge. The first group included recommendations for changes in their diabetes treatment at discharge, and the second group was discharged with the same treatment regimen they followed prior to admission
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