Hospital Discharge Algorithm Based on Admission HbA1c for the Management of Patients With Type 2 Diabetes

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 HbA(1c). Patients with HbA(1c) < 7% (53.0mmol/mol) were discharged on their preadmission diabetes therapy, HbA(1c) 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 HbA(1c) > 9% were discharged on oral antidiabetes agents (OADs) plus glargine or basal bolus regimen at 80% of inpatient dose. The primary outcome was HbA(1c) 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 HbA(1c) 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 HbA(1c) from baseline at 12 weeks after discharge was -0.1 +/- 0.6, -0.8 +/- 1.0, and -3.2 +/- 2.4 in patients with HbA(1c) < 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 HbA(1c) <= 7% (26%) compared with those with HbA(1c) > 7% (31%, P = 0.54). CONCLUSIONS Measurement of HbA(1c) on admission is beneficial in tailoring treatment regimens at discharge in general medicine and surgery patients with type 2 diabetes.