Endocr Pract. 2018 Jun;24(6):556-564. doi: 10.4158/EP-2018-0036.
Few randomized controlled trials have focused on the optimal management of patients with type 2 diabetes (T2D) during the transition from the inpatient to outpatient setting. This multicenter open-label study explored a discharge strategy based on admission hemoglobin A1c (HbA1c) to guide therapy in general medicine and surgery patients with T2D.
Patients with HbA1c ≤7% (53 mmol/mol) were discharged on sitagliptin and metformin; patients with HbA1c between 7 and 9% (53-75 mmol/mol) and those >9% (75 mmol/mol) were discharged on sitagliptinmetformin with glargine U-100 at 50% or 80% of the hospital daily dose. The primary outcome was change in HbA1c at 3 and 6 months after discharge.
Mean HbA1c on admission for the entire cohort (N = 253) was 8.70 ± 2.3% and decreased to 7.30 ± 1.5% and 7.30 ± 1.7% at 3 and 6 months ( P<.001). Patients with HbA1c <7% went from 6.3 ± 0.5% to 6.3 ± 0.80% and 6.2 ± 1.0% at 3 and 6 months. Patients with HbA1c between 7 and 9% had a reduction from 8.0 ± 0.6% to 7.3 ± 1.1% and 7.3 ± 1.3%, and those with HbA1c >9% from 11.3 ± 1.7% to 8.0 ± 1.8% and 8.0 ± 2.0% at 3 and 6 months after discharge (both P<.001). Clinically significant hypoglycemia (<54 mg/dL) was observed in 4%, 4%, and 7% among patients with a HbA1c <7%, 7 to 9%, and >9%, while a glucose <40 mg/dL was reported in <1% in all groups.
The proposed HbA1c-based hospital discharge algorithm using a combination of sitagliptin-metformin was safe and significantly improved glycemic control after hospital discharge in general medicine and surgery patients with T2D.
BG = blood glucose; DPP-4 = dipeptidyl peptidase-4; eGFR = estimated glomerular filtration rate; HbA1c = hemoglobin A1c; T2D = type 2 diabetes.
很少有随机对照试验关注 2 型糖尿病（T2D）患者从住院到门诊过渡期间的最佳管理。这项多中心开放标签研究探索了一种基于入院时血红蛋白 A1c（HbA1c）的出院策略，以指导 T2D 普通内科和外科患者的治疗。
HbA1c≤7%（53mmol/mol）的患者出院时服用西格列汀和二甲双胍；HbA1c 在 7%至 9%（53-75mmol/mol）之间和>9%（75mmol/mol）的患者出院时服用西格列汀-二甲双胍，并使用甘精 U-100 以医院日剂量的 50%或 80%给药。主要结局是出院后 3 个月和 6 个月时 HbA1c 的变化。
整个队列（N=253）的入院时平均 HbA1c 为 8.70±2.3%，降至 7.30±1.5%和 7.30±1.7%（P<.001）。HbA1c<7%的患者从 6.3±0.5%降至 6.3±0.80%和 6.2±1.0%。HbA1c 在 7%至 9%之间的患者从 8.0±0.6%降至 7.3±1.1%和 7.3±1.3%，HbA1c>9%的患者从 11.3±1.7%降至 8.0±1.8%和 8.0±2.0%（均 P<.001）。HbA1c<7%、7 至 9%和>9%的患者中分别有 4%、4%和 7%出现临床显著低血糖（<54mg/dL），所有组中<1%的患者报告血糖<40mg/dL。
该研究使用西格列汀-二甲双胍组合提出了一种基于 HbA1c 的出院算法，在普通内科和外科 T2D 患者中安全且显著改善了出院后的血糖控制。
BG=血糖；DPP-4=二肽基肽酶-4；eGFR=估计肾小球滤过率；HbA1c=血红蛋白 A1c；T2D=2 型糖尿病。
