title: Outcomes associated with post-discharge insulin continuity in US patients with type 2 diabetes mellitus initiating insulin in the hospital.
abstract: OBJECTIVE
  Hyperglycemia in hospitalized patients is associated with adverse outcomes; treatment of hyperglycemia in the hospital improves outcomes. We investigated clinical outcomes and hospital readmissions associated with insulin continuation and discontinuation post-discharge in patients with type 2 diabetes mellitus (T2DM) who initiated insulin therapy during hospitalization.
  
  
  METHODS
  This observational retrospective database analysis was performed using medical records obtained from a US coordinated health system. Patients with T2DM, glycated hemoglobin (HbA1c) levels ≥ 8.0%, naïve to insulin, and initiating insulin during hospitalization were included. Clinical outcomes and hospital readmissions were compared between patients who continued and discontinued insulin post-discharge.
  
  
  RESULTS
  Of 732 patients initiating insulin during hospitalization, 180 (24.6%) continued and 552 (75.4%) discontinued insulin. Higher mean baseline HbA1c levels were observed in patients continuing insulin compared with those discontinuing insulin (11.1% vs 9.5%; P < 0.001). A significantly higher percentage of patients continuing insulin achieved target HbA1c levels (< 7.0%) compared with those discontinuing insulin (P = 0.023), with no difference in hypoglycemia rates. In patients with a baseline HbA1c of ≥ 9.0%, insulin continuation was significantly associated with lower risks of all-cause (adjusted hazard ratio, 0.58; 95% CI, 0.36-0.93; P = 0.0276) and diabetes-related (adjusted hazard ratio, 0.46; 95% CI, 0.23-0.87; P = 0.0204) hospital readmissions.
  
  
  CONCLUSIONS
  Continuation of insulin post-discharge in insulin-naïve patients with T2DM is associated with better HbA1c target level achievement, no difference in hypoglycemia rates, and a reduced risk of hospital readmission in patients with baseline HbA1c levels ≥ 9.0%.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA. ewu@analysisgroup.com
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Steve
authors.initials: S
authors.lastname: Zhou
authors.forename: Andrew
authors.initials: A
authors.lastname: Yu
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Hari
authors.initials: H
authors.lastname: Sharma
authors.forename: Jasvinder
authors.initials: J
authors.lastname: Gill
authors.forename: Thomas
authors.initials: T
authors.lastname: Graf
mesh_terms: D000328:Adult; D000359:Aftercare; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human