Effect of Hospital Admission on Glycemic Control 1 Year After Discharge

Wei, Nancy; Grant, Richard W.; Nathan, David M.; Wexler, Deborah J.

doi:10.4158/ep11309.or

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…Based on the data obtained using CGM, the present study showed that: (i) the HbA1c level after discharge was associated with disease duration and the mean blood glucose level at discharge; and (ii) the achievement of HbA1c <7.0% after discharge was dependent on disease duration and percentage of postprandial hyperglycemia at discharge. The aim of diabetes education during hospitalization for patients with type 2 diabetes is to improve lifestyle habits and enhance treatment in a short period of time. Only a few studies have so far examined the time‐course of changes in HbA1c level after discharge.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of hemoglobin A1c level in patients with type 2 diabetes after in‐hospital diabetes education: A study based on continuous glucose monitoring

Torimoto

Okada

Sugino

et al. 2016

J of Diabetes Invest

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Aims/IntroductionWe investigated the relationship between blood glucose profile at hospital discharge, evaluated by continuous glucose monitoring (CGM), and hemoglobin A1c (HbA1c) level at 12 weeks after discharge in patients with type 2 diabetes who received inpatient diabetes education.Materials and MethodsThis was a retrospective study. The participants were 54 patients with type 2 diabetes who did not change their medication after discharge. The mean blood glucose (MBG), standard deviation, coefficient of variation, mean postprandial glucose excursion, maximum blood glucose, minimum blood glucose, percentage of time with blood glucose at ≥180 mg/dL (time at ≥180), percentage of time with blood glucose at ≥140 mg/dL, and percentage of time with blood glucose at <70 mg/dL were measured at admission and discharge using CGM. The primary end‐point was the relationship between CGM parameters and HbA1c level at 12 weeks after discharge.ResultsThe HbA1c level at 12 weeks after discharge correlated with MBG level (r = 0.30, P = 0.029). Multivariate analysis showed that MBG level and disease duration were predictors of 12‐week HbA1c level. Multivariate logistic regression analysis was carried out considering goal achievement as a HbA1c level <7.0% 12 weeks after discharge. Disease duration and time at ≥180 were associated with goal achievement.ConclusionsThe present results suggested that blood glucose profile at discharge using CGM seems useful to predict HbA1c level after discharge in patients with type 2 diabetes who received inpatient diabetes education. Early treatment to improve MBG level, as well as postprandial hyperglycemia, is important to achieve strict glycemic control.

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Section: Discussionmentioning

confidence: 99%

“…Generally speaking, the aim of the majority of inpatient diabetes education programs is to improve lifestyle habits and enhance treatment within a short period of time. Through such programs, patients learn the benefits of diet and exercise, and receive information about acute and chronic complications of diabetes and preventive measures.…”

Section: Introductionmentioning

confidence: 99%

Determinants of hemoglobin A1c level in patients with type 2 diabetes after in‐hospital diabetes education: A study based on continuous glucose monitoring

Torimoto

Okada

Sugino

et al. 2016

J of Diabetes Invest

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“…The main findings of the present study were: (i) hospitalization of patients for education about T2DM, including fine tuning medications and provision of diabetes-related educational program, improved glucose metabolism, lipid metabolism, blood pressure, and vascular endothelial function, and that (ii) hypoglycemia was associated with vascular endothelial dysfunction. Educational programs for patients with T2DM are known to correct lifestyle and enhance treatment mainly based on blood glucose control 18 , 19 . However, only a few studies have analyzed the effects of in-hospital T2DM-related educational programs on vascular endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Changes in endothelial function during educational hospitalization and the contributor to improvement of endothelial function in type 2 diabetes mellitus

Goshima

Okada

Torimoto

et al. 2020

Sci Rep

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Only a few reports have examined vascular endothelial function before and after educational hospitalization and the factors that affect it in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess vascular endothelial function before and after educational hospitalization and identify factors that affect it. In 65 patients with T2DM who underwent peripheral arterial tonometry (EndoPAT) before and after hospitalization, vascular endothelial function (reactive hyperemia index [RHI]), glucose metabolism, lipid metabolism, and blood pressure were assessed before and after hospitalization. The primary endpoint was hospitalization-induced changes in vascular endothelial function. Educational hospitalization significantly improved the natural logarithmically scaled RHI (L_RHI) from 0.555 ± 0.212 to 0.625 ± 0.245 (p = 0.012). Multivariable logistic regression analysis identified hypoglycemia during hospitalization as the single factor that significantly altered vascular endothelial function (p = 0.019). The odds of achieving normal vascular endothelial function were 0.08 times lower (95% confidence interval, 0.01–0.67) for each episode of hypoglycemia. Furthermore, multivariable analysis identified hypoglycemia during hospitalization as the single factor that worsened L_RHI. Our study showed that educational hospitalization of patients with T2DM improved vascular endothelial function, and that the development of hypoglycemic episodes had a significant negative impact on normalization of vascular endothelial function.

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“…That, along with the high proportion of patients with no post-hospitalization AHA in the current and previous studies, suggests hospitalization may not result in an appropriate re-evaluation of therapy. This may be problematic, as patients with T2DM who are hospitalized tend to have poorer glycemic control than comparable patients who are not hospitalized, and the hospitalization may present an opportunity to intervene [ 12 ]. Other literature has suggested that a hospital admission may allow an opportunity to improve long-term diabetes care [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Transitions of Care for People with Type 2 Diabetes: Utilization of Antihyperglycemic Agents Pre- and Post-Hospitalization

Montejano

McMorrow

2015

Diabetes Ther

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IntroductionLittle research to date has examined antihyperglycemic agent (AHA) utilization among patients with type 2 diabetes mellitus (T2DM) around transitions of care from inpatient to outpatient settings. Discontinuity of care between inpatient and outpatient settings has been associated with adverse clinical outcomes, so a better understanding of AHA treatment patterns is important.MethodsThis retrospective study assessed AHA utilization among a sample of United States adults with a T2DM diagnosis listed on an inpatient admission during 2010–2012 in the MarketScan® Hospital Drug database (Truven Health Analytics). AHA use while hospitalized was measured from inpatient medication administration records in that database. AHA use pre- and post-hospitalization was assessed from outpatient retail and mail order pharmacy claims in the MarketScan Commercial and Medicare Supplemental databases, which contain de-identified insurance claims from large employers and health plans. The hospital and claims databases are linked, allowing patients to be followed across transitions of care.ResultsThe study sample (N = 8144) was 53% male, with a mean age of 66 years. Twenty-one percent had no T2DM diagnosis or claims for AHAs in the 90-day pre-hospitalization period suggesting they may have been newly diagnosed at the time of admission. Most (83%) patients used AHAs while hospitalized, but the proportions with AHA claims 30 days pre- and post-hospitalization were only 53% and 40%, respectively. Biguanides and sulfonylureas were the most common outpatient agents. Most (70%) patients who had no AHA utilization pre-hospitalization continued to have no AHA utilization post-hospitalization. About half the patients with AHA claims pre-hospitalization did not have any AHA claims post-discharge.ConclusionFurther research is warranted to explore the reasons why AHAs are not continued following hospital discharge. Inadequate treatment of T2DM remains an issue before and after hospitalization; inpatient stays represent an important and frequently missed opportunity to assess and optimize care for these patients.FundingJanssen Scientific Affairs, LLC.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0148-5) contains supplementary material, which is available to authorized users.

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Effect of Hospital Admission on Glycemic Control 1 Year After Discharge

Cited by 13 publications

References 23 publications

Determinants of hemoglobin A1c level in patients with type 2 diabetes after in‐hospital diabetes education: A study based on continuous glucose monitoring

Determinants of hemoglobin A1c level in patients with type 2 diabetes after in‐hospital diabetes education: A study based on continuous glucose monitoring

Changes in endothelial function during educational hospitalization and the contributor to improvement of endothelial function in type 2 diabetes mellitus

Transitions of Care for People with Type 2 Diabetes: Utilization of Antihyperglycemic Agents Pre- and Post-Hospitalization

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