Survey on Transition from Inpatient to Outpatient for Patients on Insulin: What Really Goes on at Home?

Kimmel, Bonnie; Sullivan, Mary M.; Rushakoff, Robert J

doi:10.4158/ep10013.or

Cited by 28 publications

(24 citation statements)

References 8 publications

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“…Providing patients and their family members with information on how to manage their diabetes drugs during periods of acute illness can reduce the metabolic decompensation that can occur with inappropriate reductions or omissions of insulin doses 87. In addition, ensuring that patients have access to their diabetes drugs, including the ability to pay for these drugs, is important in preventing readmissions 8889…”

Section: Prevention Of Diabetic Ketoacidosis and Hhsmentioning

confidence: 99%

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

136

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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Section: Prevention Of Diabetic Ketoacidosis and Hhsmentioning

confidence: 99%

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

136

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“…In diabetes management, it is likely to fuel interest in research on the impact of inpatient diabetes management on outpatient outcomes and overall cost-effectiveness (7, 12, 22). Previous studies have shown that sustained reductions in A1C of >1% for over 1 year are associated with significant cost savings within 1 to 2 years of improvement, regardless of baseline complications, and that every 1% increase in A1C above 7% significantly increases medical costs over the following 3 years (23, 24).…”

Section: Discussionmentioning

confidence: 99%

“…One-quarter of hospitalized patients have diabetes, with average A1C at the time of admission ranging from 7.4 ± 1.7% to 8.5 ± 2.6% in recently published studies (4–6). Most studies of inpatient interventions on glycemic control have focused on immediate outcomes, such as inhospital morbidity/mortality and glycemic excursions, and not on its impact on subsequent outpatient glycemic control (7–9). …”

Section: Introductionmentioning

confidence: 99%

“…In addition, more clinical focus is being placed on improving transitions of care from the inpatient to outpatient setting to reduce the risk associated with hospital discharge itself (7, 11, 12). In this context, the impact of hospitalization on long-term glycemic control could be used as a measure of the effect of clinical interventions (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Hospital Admission on Glycemic Control 1 Year After Discharge

et al. 2012

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Objective We assessed the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge. Methods We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values prior to admission and 1 year after discharge. We compared them to 826 age-, sex-, race-, co-morbidity- and baseline A1C-matched non-hospitalized adults with diabetes. We determined change in A1C relative to hospitalization and baseline A1C using multivariate random effects models for repeated measures. Logistic regression was used to determine predictors of achieving recommended A1C levels at 1 year. Results Patients with baseline A1C≥9% (adjusted mean A1C 9.90% [95% CI 9.25, 10.55]) had an adjusted change in A1C of −0.10% per month ([95% CI −0.18, −0.022], p<0.01) over the course of 1 year without differences between hospitalized and non-hospitalized patients in the mean rate of change. However, hospitalized patients were less likely to achieve an A1C ≤7% at one year (OR 0.68 [95% CI 0.55, 0.86], p<0.01) or A1C <8% at one year (OR 0.62 [95% CI 0.48, 0.81], p<0.01) compared to non-hospitalized patients. Conclusions Despite an overall trend towards improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year compared to matched non-hospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.

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“…Study results also revealed a substantial discrepancy between patients' and investigators' perceptions regarding glycemic control in the week following discharge: 79% of patients believed that they had good control versus investigators, who believed that 53% of patients had good control. 19 Practices that are essential to transitioning the patient with prior or newly diagnosed diabetes from inpatient to outpatient care include education regarding all of the issues considered above (eg, treatment goals; SMBG; insulin selfadministration [if necessary]; hypoglycemia prevention, recognition, and treatment; hyperglycemia recognition; and when to call a clinician for help). It is also important that the discharge plan be shared with the patient's primary care physician.…”

Section: General Considerations In the Transition From Inpatient To Omentioning

confidence: 99%

Transitioning From Inpatient to Outpatient Therapy in Patients with In-Hospital Hyperglycemia

Peterson

2011

Hospital Practice

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Transition from inpatient to outpatient care for patients with type 2 diabetes mellitus is an important aspect of patient management for which there is no guidance. Intensive glucose lowering with insulin is generally favored for seriously ill hospitalized patients, but after discharge, patients often resume their prior regimens, which may include an array of oral or injected glucose-lowering agents. Factors that should be considered in this transition include goals of care/life expectancy, glycated hemoglobin at hospital admission, home medications for other illnesses and their potential for interactions with antidiabetes treatment, comorbidities, nutritional status, physical disabilities, ability to carry out self-monitoring of blood glucose, risk for hypoglycemia, contraindications to oral medications, health literacy, and financial and other resources. Traditional oral therapies that may be used after the patient leaves the hospital include sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, and metformin. α-Glucosidase inhibitors are limited by gastrointestinal adverse events, and thiazolidinediones by fluid retention and increased risk for heart failure. Thiazolidinediones also require a long period of administration for onset glucose lowering and are not suitable for transitioning hospitalized patients who have been receiving insulin to outpatient care. Metformin is contraindicated in patients with renal, cardiac, or pulmonary insufficiency. Incretin-based therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, have limited use in hospitals, but may be suitable for the transition to outpatient treatment. The most common adverse events with glucagon-like peptide-1 inhibitors involve the gastrointestinal system. More formal studies of treatment regimens for patients with hyperglycemia leaving the hospital are needed to guide care for this group.

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Survey on Transition from Inpatient to Outpatient for Patients on Insulin: What Really Goes on at Home?

Cited by 28 publications

References 8 publications

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Effect of Hospital Admission on Glycemic Control 1 Year After Discharge

Transitioning From Inpatient to Outpatient Therapy in Patients with In-Hospital Hyperglycemia

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