title: Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm.
abstract: Type 2 diabetes (T2D) exists in 25-40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3-6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Lucas Martín
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Guanyabens
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Zavala-Arauco
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Chamorro
authors.affiliation: Hormone Laboratory, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Granada
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Didac
authors.initials: D
authors.lastname: Mauricio
authors.affiliation: Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Puig-Domingo