title: Intensification of diabetes medication and risk for 30-day readmission.
abstract: OBJECTIVE
  To examine the association of in-hospital diabetes regimen intensification with subsequent 30-day risk for unplanned readmission/emergency department admission.
  
  
  METHODS
  We retrospectively studied 1949 adults with Type 2 diabetes receiving primary care within an academic health network admitted to the hospital between January 2007 and December 2009. Glucose therapy intensification was defined as new start of insulin or oral hypoglycaemic agents, or addition of prandial insulin or insulin mixtures. The association of glucose therapy intensification with subsequent 30-day risk for unplanned readmission/emergency department admission was examined, with focus on medicine service patients with poorly controlled glycaemia (baseline HbA(1c)  ≥ 64 mmol/mol).
  
  
  RESULTS
  One in six patients (324/1949, 17%) had early readmission/emergency department admission. Compared with patients without early readmission, readmitted patients were more often male (58 vs. 52%, P = 0.03), had higher Charlson co-morbidity score [mean (sd) 3.0 (2.0) vs. 2.8 (1.8), P = 0.02], longer length of stay [5 (4.4) vs. 3.9 (3.3) days, P < 0.01] and were more often discharged home with nursing services (38 vs. 32%, P = 0.03). Overall, glucose therapy intensification was not associated with early hospital readmission/emergency department admission (odds ratio 0.94, 95% CI 0.64-1.37, P = 0.74). However, among medicine service patients with baseline HbA(1c)  ≥ 64 mmol/mol (8%), glucose therapy intensification was associated with a significantly decreased early readmission risk (adjusted odds ratio 0.33, 95% CI 0.12-0.88, P = 0.03) and lower post-discharge HbA(1c)  {mean decrease (sd): 20 (26) mmol/mol [1.8 (2.4)%] vs. 7 (15) mmol/mol [0.6 (1.4)%], P < 0.01}.
  
  
  CONCLUSIONS
  Diabetes medical regimen intensification during hospitalization was not associated with early readmission. Among patients with elevated HbA(1c) , glucose therapy intensification was associated with a decreased 30-day readmission/emergency department admission risk and lower outpatient HbA(1c)  levels. Our findings support the safety and durable impact of diabetes regimen optimization during hospital admission.
authors.affiliation: Massachusetts General Hospital, Diabetes Center; Harvard Medical School, Boston, MA, USA. ncwei@partners.org
authors.forename: N J
authors.initials: NJ
authors.lastname: Wei
authors.forename: D J
authors.initials: DJ
authors.lastname: Wexler
authors.forename: D M
authors.initials: DM
authors.lastname: Nathan
authors.forename: R W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human