Antidiabetic Therapy Before and 1 Year After Discharge for Patients Manifesting In-Hospital Hyperglycemia

Abstract

Background: While studies have evaluated the impact of hyperglycemia during hospitalization, little is known about its management before and after admission. Methods: We sampled a managed care outpatient database (8547 patients) with linkage to inpatient data from June 1, 2003 to June 30, 2006, evaluating hyperglycemia management preadmission (PA), during index admission (IA), and postdischarge (PD). Antihyperglycemic medications used during PA, IA, and PD for up to 15 months were available for 2898 patients from this cohort. Diabetes mellitus (DM) status was determined from ICD-9 codes. Results: Patients at IA had an average age of 60 ± 18 years. Forty-one percent were men and 59% were women. Nearly 60% of patients either had DM or manifested hyperglycemia (blood glucose > 130 mg/dL): 19.5% (1627) had preexisting DM (DM+); 9.6% (801) were newly diagnosed with DM at IA; 28.6% (2391) did not have DM (DM–) but manifested hyperglycemia during hospitalization; and 36.9% (3083) remained normoglycemic. The DM status of 459 patients (5.4%) was unascertainable. For the previously diagnosed DM+ patients, antidiabetic therapy intensified more than 2-fold during IA, primarily with insulin. Postdischarge hyperglycemia management medication doubled, with increases seen in both oral hypoglycemic agents (OHAs) and insulin. Newly diagnosed DM+ patients were also treated primarily with insulin during hospitalization and reverted to OHAs PD. A minority of DM– patients received antidiabetic therapy during IA, primarily with insulin, but 4% were diagnosed DM+ in the 15-month period PD and treated primarily with OHAs. Among those normoglycemic in the hospital, 1% were diagnosed with DM and treated with OHAs PD. Conclusion: Hyperglycemia management was intensified for all DM+ patients, primarily with insulin in the hospital and both insulin and OHAs PD. A better understanding of this natural history and antidiabetic transitional care could facilitate better discharge planning and thus improve diabetes care.

Keywords:

• diabetes
• hyperglycemia
• hospital management