Effect of hospital admission on glycemic control 1 year after discharge.
OBJECTIVE
To assess 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 for 6 months before admission and 1 year after discharge. We compared them with 826 nonhospitalized adults with diabetes matched for age, sex, race, comorbidity, and baseline A1C level. We determined the change in A1C value relative to hospitalization and baseline A1C level by using multivariate random effects models for repeated measures. Logistic regression analysis was performed to determine predictors of achieving recommended A1C levels at 1 year.


RESULTS
Patients with baseline A1C levels ≥9% had an adjusted rate of change in A1C value of -0.10% per month (95% confidence interval [CI], -0.18 to -0.022; P=.012) during the course of 1 year, without significant differences between hospitalized and nonhospitalized patients in the mean rate of change. Hospitalized patients, however, were less likely to achieve an A1C goal of ≤7% at 1 year (odds ratio, 0.68; 95% CI, 0.55 to 0.86; P<.001) or an A1C of <8% at 1 year (odds ratio, 0.62; 95% CI, 0.48 to 0.81; P<.001) in comparison with the nonhospitalized patients.


CONCLUSIONS
Despite an overall trend toward improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year in comparison with matched nonhospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.
Diabetes Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA. ncwei@partners.org
Nancy J
NJ
Wei
Richard W
RW
Grant
David M
DM
Nathan
Deborah J
DJ
Wexler
D000046:Academic Medical Centers; D000368:Aged; D001900:Boston; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D012189:Retrospective Studies; D014504:Urban Health
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human