Effect of Hospital Admission on Glycemic Control One Year after Discharge.
Endocr Pract. 2012 Jan 9;:1-22
Authors: Wei NJ, Grant RW, Nathan DM, Wexler DJ
Objective: We assessed the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge.Methods: We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values prior to admission and 1 year after discharge. We compared them to 826 age-, sex-, race-, co-morbidity- and baseline A1C-matched non-hospitalized adults with diabetes. We determined change in A1C relative to hospitalization and baseline A1C using multivariate random effects models for repeated measures. Logistic regression was used to determine predictors of achieving recommended A1C levels at 1 year. Results: Patients with baseline A1C ?9% (adjusted mean A1C 9.90% [95% CI 9.25, 10.55]) had an adjusted change in A1C of -0.10% per month ([95% CI -0.18, -0.022], p<0.01) over the course of 1 year without differences between hospitalized and non-hospitalized patients in the mean rate of change. However, hospitalized patients were less likely to achieve an A1C ?7% at one year (OR 0.68 [95% CI 0.55, 0.86], p<0.01) or A1C <8% at one year (OR 0.62 [95% CI 0.48, 0.81], p<0.01) compared to non-hospitalized patients.Conclusions: Despite an overall trend towards improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year compared to matched non-hospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.
PMID: 22232028 [PubMed - as supplied by publisher]