Abusamaan Mohammed S, Fesseha Voss Betiel, Kim Han Na, Reyes-DeJesus Dalilah, Langan Susan, Niessen Timothy M, Mathioudakis Nestoras N
Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
J Clin Transl Endocrinol. 2020 Feb 19;20:100220. doi: 10.1016/j.jcte.2020.100220. eCollection 2020 Jun.
Diabetes mellitus is a prevalent condition among hospitalized patients and the inpatient setting presents an opportunity for providers to review and adjust antihyperglycemic medications. We sought to describe practice patterns and predictors of antihyperglycemic intensification (AHI) at hospital discharge for type 2 diabetes mellitus (T2DM) patients not on home insulin.
We conducted a retrospective study of adult patients with T2DM receiving either non-insulin antihyperglycemic (NIA) or no antihyperglycemic medications prior to admission who were hospitalized within two hospitals in the Johns Hopkins Health System from December 2015 to September 2016. Mean hospital glucose values and observed vs. individualized target hemoglobin A1C values (based on risk of mortality score) were used to define an indication for AHI. Multivariable logistic regression was used to identify predictors of AHI.
A total of 554 discharges of 475 unique patients were included. An indication for AHI was present in 104 (18.8%) of discharges, and AHI occurred in 30 (28.8%) of these discharges. Higher mean admission BG values and A1C, fewer pre-admission antihyperglycemic agents, involvement of the diabetes service, and admitting service were associated with AHI, while no association was observed with age, sex, race, risk of mortality and severity of illness scores, or length of stay. AHI was not associated with 30-day readmission.
An indication for AHI occurs relatively infrequently among hospitalized patients, but when present, AHI occurs in approximately 1 in 3 discharges. AHI appears to be related largely to the degree of hyperglycemia, and diabetes service involvement. Further studies are needed to understand the implications of AHI at hospital discharge on short and long-term outcomes in this population.
糖尿病在住院患者中很常见，住院环境为医护人员提供了一个审查和调整降糖药物的机会。我们试图描述未使用家庭胰岛素的2型糖尿病（T2DM）患者出院时降糖强化治疗（AHI）的实践模式和预测因素。
我们对2015年12月至2016年9月在约翰霍普金斯医疗系统内两家医院住院的成年T2DM患者进行了一项回顾性研究，这些患者在入院前接受非胰岛素降糖（NIA）药物治疗或未接受任何降糖药物治疗。采用平均住院血糖值以及观察到的与个体化目标糖化血红蛋白A1C值（基于死亡风险评分）来确定AHI的指征。使用多变量逻辑回归来识别AHI的预测因素。
共纳入475例独特患者的554次出院病例。104次（18.8%）出院病例存在AHI指征，其中30次（28.8%）出院病例发生了AHI。较高的平均入院血糖值和A1C、入院前较少的降糖药物、糖尿病专科服务的参与以及收治科室与AHI相关，而未观察到与年龄、性别、种族、死亡风险和疾病严重程度评分或住院时间有关。AHI与30天再入院无关。
住院患者中AHI指征相对较少出现，但一旦出现，约三分之一的出院病例会发生AHI。AHI似乎主要与高血糖程度和糖尿病专科服务参与有关。需要进一步研究以了解出院时AHI对该人群短期和长期结局的影响。
