Outcomes Associated With Insulin Therapy Disruption After Hospital Discharge Among Patients with Type 2 Diabetes Mellitus who Had Used Insulin Before and During Hospitalization

Wu, Eric Q.; Zhou, Steve; Yu, Andrew P.; Lu, Mengji; Sharma, Hari; Gill, Jasvinder; Graf, Thomas

doi:10.4158/ep11314.or

Cited by 16 publications

(29 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in healthcare delivery models (i.e., accountable care organizations) putting providers and hospitals at risk for outcomes across the care continuum have led to increasing interest in the transition from inpatient to outpatient care, especially for high-risk medications and patient populations (13–15). Patients with diabetes on insulin therapy are both, and as such make a good test case for exploring new modalities in care across the care continuum.…”

Section: Resultsmentioning

confidence: 99%

Glycemic Control After Hospital Discharge in Insulin-Treated Type 2 Diabetes: A Randomized Pilot Study of Daily Remote Glucose Monitoring

2015

View full text Add to dashboard Cite

Objective Little is known about glycemic control in type 2 diabetes patients treated with insulin in the high-risk period between hospital discharge and follow-up. We sought to assess the impact of remote glucose monitoring on postdischarge glycemic control and insulin titration. Methods We randomly assigned 28 hospitalized type 2 diabetes patients who were discharged home on insulin therapy to routine specialty care (RSC) or RSC with daily remote glucose monitoring (RGM). We compared the primary outcome of mean blood glucose and exploratory outcomes of hypoglycemia/hyperglycemia rates, change in hemoglobin A1c and glycated albumin, and insulin titration frequency between groups. Results Mean blood glucose was not significantly different between the treatment arms (144 ± 34 mg/dL in the RSC group and 172 ± 41 mg/dL in the RGM group; not significant), nor were there significant differences in any of the other measures of glycemia during the month after discharge. Hypoglycemia (glucometer reading <60 mg/dL) was common, occurring in 46% of subjects, with no difference between groups. In as-treated analysis, insulin dose adjustments (29% with an increase and 43% with decrease in insulin dose) occurred more frequently in the patients who used RGM (average of 2.8 vs. 1.2 dose adjustments; P = .03). Conclusion In this pilot trial in insulin-treated type 2 diabetes, RGM did not affect glycemic control after hospital discharge; however, the high rate of hypoglycemia in the postdischarge transition period and the higher frequency of insulin titration in patients who used RGM suggest a safety role for such monitoring in the transition from hospital to home.

show abstract

Section: Resultsmentioning

confidence: 99%

Glycemic Control After Hospital Discharge in Insulin-Treated Type 2 Diabetes: A Randomized Pilot Study of Daily Remote Glucose Monitoring

2015

View full text Add to dashboard Cite

show abstract

“…This dataset has been widely used to address the health economic evaluations in real-world settings. [22-26]…”

Section: Methodsmentioning

confidence: 99%

The association of body mass index with the risk of type 2 diabetes: a case–control study nested in an electronic health records system in the United States

Ganz

Wintfeld

et al. 2014

Diabetol Metab Syndr

198

140

View full text Add to dashboard Cite

ObjectivesObesity is a known risk factor for type 2 diabetes (T2D). We conducted a case–control study to assess the association between body mass index (BMI) and the risk of being diagnosed with T2D in the United States.MethodsWe selected adults (≥ 18 years old) who were diagnosed with T2D (defined by ICD-9-CM diagnosis codes or use of anti-diabetic medications) between January 2004 and October 2011 (“cases”) from an electronic health records database provided by an integrated health system in the Middle Atlantic region. Twice as many individuals enrolled in the health system without a T2D diagnosis during the study period (“controls”) were selected based on age, sex, history of cardiac comorbidities or hyperinflammatory state (defined by C-reactive protein and erythrocyte sedimentation rate), and use of psychiatric or beta blocker medications. BMI was measured during one year prior to the first observed T2D diagnosis (for cases) or a randomly assigned date (for controls); individuals with no BMI measure or BMI < 18.5 kg/m2 were excluded. We assessed the impact of increased BMI (overweight: 25–29.9 kg/m2; Obesity Class I: 30–34.9 kg/m2; Obesity Class II: 35–39.9 kg/m2; Obesity Class III: ≥40 kg/m2), relative to normal BMI (18.5–24.9 kg/m2), on a T2D diagnosis using odds ratios (OR) and relative risks (RR) estimated from multiple logistic regression results.ResultsWe included 12,179 cases (mean age: 55, 43% male) and 25,177 controls (mean age: 56, 45% male). We found a positive association between BMI and the risk of a T2D diagnosis. The strength of this association increased with BMI category (RR [95% confidence interval]: overweight, 1.5 [1.4–1.6]; Obesity Class I, 2.5 [2.3–2.6]; Obesity Class II, 3.6 [3.4–3.8]; Obesity Class III, 5.1 [4.7–5.5]).ConclusionsBMI is strongly and independently associated with the risk of being diagnosed with T2D. The incremental association of BMI category on the risk of T2D is stronger for people with a higher BMI relative to people with a lower BMI.

show abstract

“…Second, insulin therapy post-discharge is associated with a lower risk of readmission at 1 year. In a study of patients with type 2 diabetes who used insulin before and during hospitalization, patients who continued insulin after discharge had lower risks of allcause and diabetes-related readmission within 12 months compared to patients who did not continue the insulin [41]. A companion study of insulin-naïve type 2 diabetes patients with baseline A1c levels ≥8 % who initiated insulin during hospitalization found a trend for an association between insulin continuation and lower risk of readmission [42].…”

Section: Readmission Beyond 30 Days After Dischargementioning

confidence: 99%

Correction to: Hospital Readmission of Patients with Diabetes

Rubin

2018

Curr Diab Rep

View full text Add to dashboard Cite

show abstract

Outcomes Associated With Insulin Therapy Disruption After Hospital Discharge Among Patients with Type 2 Diabetes Mellitus who Had Used Insulin Before and During Hospitalization

Cited by 16 publications

References 13 publications

Glycemic Control After Hospital Discharge in Insulin-Treated Type 2 Diabetes: A Randomized Pilot Study of Daily Remote Glucose Monitoring

Glycemic Control After Hospital Discharge in Insulin-Treated Type 2 Diabetes: A Randomized Pilot Study of Daily Remote Glucose Monitoring

The association of body mass index with the risk of type 2 diabetes: a case–control study nested in an electronic health records system in the United States

Correction to: Hospital Readmission of Patients with Diabetes

Contact Info

Product

Resources

About