Guillermo E Umpierrez1, David Reyes2, Dawn Smiley2, Kathie Hermayer3, Amna Khan4, Darin E Olson5, Francisco Pasquel2, Sol Jacobs2, Christopher Newton2, Limin Peng6, Vivian Fonseca4. 1. Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA geumpie@emory.edu. 2. Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA. 3. Division of Endocrinology, Department of Medicine, Medical University of South Carolina, Charleston, SC. 4. Division of Endocrinology, Department of Medicine, Tulane Medical Center, New Orleans, LA. 5. Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA Atlanta Veterans Affairs Medical Center, Decatur, GA. 6. Rollins School of Public Health, Emory University, Atlanta, GA.
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 admissionHbA1c ≤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.
RCT Entities:
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.
Authors: Stephen Clement; Susan S Braithwaite; Michelle F Magee; Andrew Ahmann; Elizabeth P Smith; Rebecca G Schafer; Irl B Hirsch; Irl B Hirsh Journal: Diabetes Care Date: 2004-02 Impact factor: 19.112
Authors: Guillermo E Umpierrez; Richard Hellman; Mary T Korytkowski; Mikhail Kosiborod; Gregory A Maynard; Victor M Montori; Jane J Seley; Greet Van den Berghe Journal: J Clin Endocrinol Metab Date: 2012-01 Impact factor: 5.958
Authors: Greet Van den Berghe; Pieter J Wouters; Roger Bouillon; Frank Weekers; Charles Verwaest; Miet Schetz; Dirk Vlasselaers; Patrick Ferdinande; Peter Lauwers Journal: Crit Care Med Date: 2003-02 Impact factor: 7.598
Authors: Guillermo E Umpierrez; Dawn Smiley; Ariel Zisman; Luz M Prieto; Andres Palacio; Miguel Ceron; Alvaro Puig; Roberto Mejia Journal: Diabetes Care Date: 2007-05-18 Impact factor: 19.112
Authors: Curtiss B Cook; Karen M Seifert; Bryan P Hull; Michael J Hovan; Joseph C Charles; Victoria Miller-Cage; Mary E Boyle; Jana K Harris; Jan M Magallanez; Stephanie D Littman Journal: Endocr Pract Date: 2009-04 Impact factor: 3.443
Authors: Ute Mons; Elke Raum; Heike U Krämer; Gernot Rüter; Dietrich Rothenbacher; Thomas Rosemann; Joachim Szecsenyi; Hermann Brenner Journal: PLoS One Date: 2013-10-30 Impact factor: 3.240
Authors: Roma Y Gianchandani; Francisco J Pasquel; Daniel J Rubin; Kathleen M Dungan; Priyathama Vellanki; Heqiong Wang; Isabel Anzola; Patricia Gomez; Israel Hodish; Sangeeta Lathkar-Pradhan; Jennifer Iyengar; Guillermo E Umpierrez Journal: Endocr Pract Date: 2018-06 Impact factor: 3.443
Authors: Elias K Spanakis; Guillermo E Umpierrez; Tariq Siddiqui; Min Zhan; Soren Snitker; Jeffrey C Fink; John D Sorkin Journal: J Clin Endocrinol Metab Date: 2019-09-01 Impact factor: 5.958
Authors: Derek LeRoith; Geert Jan Biessels; Susan S Braithwaite; Felipe F Casanueva; Boris Draznin; Jeffrey B Halter; Irl B Hirsch; Marie E McDonnell; Mark E Molitch; M Hassan Murad; Alan J Sinclair Journal: J Clin Endocrinol Metab Date: 2019-05-01 Impact factor: 5.958