title: Transitions of Care for People with Type 2 Diabetes: Utilization of Antihyperglycemic Agents Pre- and Post-Hospitalization.
abstract: BACKGROUND
  Little research to date has examined antihyperglycemic agent (AHA) utilization among patients with type 2 diabetes mellitus (T2DM) around transitions of care from inpatient to outpatient settings. Discontinuity of care between inpatient and outpatient settings has been associated with adverse clinical outcomes, so a better understanding of AHA treatment patterns is important.
  
  
  METHODS
  This retrospective study assessed AHA utilization among a sample of United States adults with a T2DM diagnosis listed on an inpatient admission during 2010-2012 in the MarketScan(®) Hospital Drug database (Truven Health Analytics). AHA use while hospitalized was measured from inpatient medication administration records in that database. AHA use pre- and post-hospitalization was assessed from outpatient retail and mail order pharmacy claims in the MarketScan Commercial and Medicare Supplemental databases, which contain de-identified insurance claims from large employers and health plans. The hospital and claims databases are linked, allowing patients to be followed across transitions of care.
  
  
  RESULTS
  The study sample (N = 8144) was 53% male, with a mean age of 66 years. Twenty-one percent had no T2DM diagnosis or claims for AHAs in the 90-day pre-hospitalization period suggesting they may have been newly diagnosed at the time of admission. Most (83%) patients used AHAs while hospitalized, but the proportions with AHA claims 30 days pre- and post-hospitalization were only 53% and 40%, respectively. Biguanides and sulfonylureas were the most common outpatient agents. Most (70%) patients who had no AHA utilization pre-hospitalization continued to have no AHA utilization post-hospitalization. About half the patients with AHA claims pre-hospitalization did not have any AHA claims post-discharge.
  
  
  CONCLUSIONS
  Further research is warranted to explore the reasons why AHAs are not continued following hospital discharge. Inadequate treatment of T2DM remains an issue before and after hospitalization; inpatient stays represent an important and frequently missed opportunity to assess and optimize care for these patients.
  
  
  BACKGROUND
  Janssen Scientific Affairs, LLC.
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA. leslie.montejano@truvenhealth.com.
authors.forename: Leslie
authors.identifier: http://orcid.org/0000-0002-4542-7257
authors.initials: L
authors.lastname: Montejano
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Lien
authors.initials: L
authors.lastname: Vo
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: McMorrow
keywords: Antihyperglycemic agents; Hospitalization; Transitions of care; Treatment; Type 2 diabetes mellitus