title: Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes.
abstract: OBJECTIVE
  Effective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes.
  
  
  METHODS
  This was a prospective, multicenter open-label study aimed to determine the safety and efficacy of a hospital discharge algorithm based on admission HbA1c. Patients with HbA1c <7% (53.0 mmol/mol) were discharged on their preadmission diabetes therapy, HbA1c between 7 and 9% (53.0-74.9 mmol/mol) were discharged on a preadmission regimen plus glargine at 50% of hospital daily dose, and HbA1c >9% were discharged on oral antidiabetes agents (OADs) plus glargine or basal bolus regimen at 80% of inpatient dose. The primary outcome was HbA1c concentration at 12 weeks after hospital discharge.
  
  
  RESULTS
  A total of 224 patients were discharged on OAD (36%), combination of OAD and glargine (27%), basal bolus (24%), glargine alone (9%), and diet (4%). The admission HbA1c was 8.7 ± 2.5% (71.6 mmol/mol) and decreased to 7.3 ± 1.5% (56 mmol/mol) at 12 weeks of follow-up (P < 0.001). The change of HbA1c from baseline at 12 weeks after discharge was -0.1 ± 0.6, -0.8 ± 1.0, and -3.2 ± 2.4 in patients with HbA1c <7%, 7-9%, and >9%, respectively (P < 0.001). Hypoglycemia (<70 mg/dL) was reported in 22% of patients discharged on OAD only, 30% on OAD plus glargine, 44% on basal bolus, and 25% on glargine alone and was similar in patients with admission HbA1c ≤7% (26%) compared with those with HbA1c >7% (31%, P = 0.54).
  
  
  CONCLUSIONS
  Measurement of HbA1c on admission is beneficial in tailoring treatment regimens at discharge in general medicine and surgery patients with type 2 diabetes.
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA geumpie@emory.edu.
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: David
authors.initials: D
authors.lastname: Reyes
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smiley
authors.affiliation: Division of Endocrinology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Kathie
authors.initials: K
authors.lastname: Hermayer
authors.affiliation: Division of Endocrinology, Department of Medicine, Tulane Medical Center, New Orleans, LA.
authors.forename: Amna
authors.initials: A
authors.lastname: Khan
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA Atlanta Veterans Affairs Medical Center, Decatur, GA.
authors.forename: Darin E
authors.initials: DE
authors.lastname: Olson
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pasquel
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Sol
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Division of Endocrinology, Department of Medicine, Tulane Medical Center, New Orleans, LA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting