FRI641 Assessing Insulin Prescription Adequacy At Hospital Discharge And Its Association With Characteristics Of Diabetic Patients

Abstract

Abstract Disclosure: T. Akcan: None. S. Sharma: None. J. Liu: None. A. Jayarangaiah: None. M. Gilani: None. A. Surendran: None. N. Imamudeen: None. R. Gabor: None. R.D. Pathak: None. Diabetes is becoming increasingly prevalent, and appropriate insulin therapy during the post-discharge period is essential to improve glycemic control and reduce readmissions. Despite extensive research on insulin use during hospitalization, little is known about insulin dosing at discharge and patient factors that affect post-discharge needs. Therefore, this retrospective study aimed to evaluate the adequacy of insulin dosing at hospital discharge for diabetic patients and identify patient characteristics impacting post-discharge insulin requirements. Using a retrospective study design, we identified 350 patients meeting the inclusion criteria. The results showed that 19.1% of patients required a decrease in insulin total daily dose (TDD) at follow-up, 50.9% experienced no change, and 30.0% necessitated an increase. Factors found to impact insulin dose adjustments post-discharge include BMI, CKD, discharge TDD, and HbA1c levels. The multivariate analysis revealed that CKD was associated with a decrease in insulin TDD at follow-up (95% CI: -9.65- -0.47, p=0.031). Additionally, insulin TDD at discharge was negatively associated with follow-up dose, with a 0.37 unit decrease (95% CI: -0.44- -0.30, p<0.001) in insulin TDD for each additional unit prescribed. Finally, there was a marginal significance observed in the discharge regimen. Patients on a premixed regimen had a decrease in insulin TDD at follow-up compared to those on a basal-bolus regimen (95% CI: -21.85- 0.27, p=0.057). Our study findings suggest the need for improved estimation of insulin doses at discharge and emphasize the importance of short-term follow-up for insulin titration post-discharge. Patient factors such as body weight, kidney disease, insulin dose at discharge, and HbA1c levels influence these changes. These findings have significant implications for optimizing patient outcomes and reducing hospital readmissions, underscoring the importance of carefully evaluating these factors when tailoring individualized insulin regimens. Presentation: Friday, June 16, 2023