https://diabetes.acponline.org/archives/2014/09/12/7.htm

HbA1c can be used to choose postdischarge diabetes medications

Basing hospitalized diabetes patients' postdischarge prescriptions on an HbA1c taken at admission was associated with improvements in glycemic control, a recent study found.


Basing hospitalized diabetes patients' postdischarge prescriptions on an HbA1c taken at admission was associated with improvements in glycemic control, a recent study found.

The multicenter, open-label study included 224 patients with type 2 diabetes admitted to either general medicine or surgery wards. Their HbA1c levels were measured at admission and at 12 weeks after discharge. According to the algorithm, patients with an admission HbA1c <7% were discharged on their preadmission diabetes therapy and patients with an HbA1c between 7% and 9% were discharged on their preadmission regimen plus glargine at 50% of the hospital daily dose. Those with an HbA1c >9% were discharged on oral antidiabetes agents plus glargine or a basal bolus regimen at 80% of their inpatient dose.

The average HbA1c of studied patients at admission was 8.7%, and it had dropped to 7.3% at 12 weeks after discharge (P<0.001). Patients in the <7% group had an average −0.1 drop in HbA1c, compared to −0.8 in the middle group and −3.2 in the HbA1c >9% group. Hypoglycemia, defined as glucose <70 mg/dL (3.89 mmol/L) was reported by similar percentages of patients in the <7% and >9% groups and was highest (44%) in those taking basal bolus, followed by orals plus glargine (30%), then glargine alone (25%) and orals alone (22%). Overall, 36% of the patients were discharged on only oral drugs, 27% on orals and glargine, 24% on basal bolus, 9% on glargine alone, and 4% on just diet.

Measuring HbA1c at admission can help with tailoring a postdischarge treatment regimen for type 2 diabetes patients, the study authors concluded. The algorithm resulted in “an acceptable rate of hypoglycemia,” 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. Larger, longer studies are needed to determine the full impact of improving glycemic control after hospitalization, the authors said. The study was published online by Diabetes Care on Aug. 28.