Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes
Open accessAbstract
OBJECTIVE: Effective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes. RESEARCH DESIGN AND 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.
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Inpatient treatment and discharge planning are more effective when preadmission glycemia is considered.
“because inpatient treatment and discharge planning are more effective when preadmission glycemia is considered”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [4]
The Conclusions (page not specified in our copy) say that admission HbA1c helped tailor treatment at discharge and that the discharge algorithm improved HbA1c over 12 weeks. The study does not show that considering preadmission glycemia made treatment during the hospital stay more effective, nor does it compare discharge planning with and without that information. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe discharge algorithm significantly improved A1C after discharge.
“and significantly improved A1C after discharge (4).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [4]
A discharge algorithm for glycemic medication adjustment based on admission A1C, diabetes medications before admission, and insulin usage during hospitalization was found useful to guide treatment decisions.
“A discharge algorithm for glycemic medication adjustment, based on admission A1C, diabetes medications before admission, and insulin usage during hospitalization was found useful to guide treatment decisions”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [4]
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References 31 · Cited by 130
Research works printed but not linked: 13
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- Authors
- Umpierrez, G. E., Reyes, D., Smiley, D., Hermayer, K., Khan, A., Olson, D. E., Pasquel, F., Jacobs, S., Newton, C., Peng, L., & Fonseca, V.
- Affiliations
- Emory University (US)
- Medical University of South Carolina (US)
- Tulane Medical Center (US)
- Corresponding author
- Umpierrez, Guillermo E.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-10-10
- Volume
- 37
- Issue
- 11
- Pages
- 2934-2939
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4207201
- OpenAlex
- W2091623772
- Cited by
- 130
- References
- 31
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 11 · 2023: 13 · 2022: 9 · 2021: 8 · 2020: 14 · 2019: 13 · 2018: 19 · 2017: 9 · 2016: 11 · 2015: 9 · 2012: 1
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000454)
- National Institute of General Medical Sciences (U54GM104940)
- National Center for Research Resources (UL1RR025008)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- type 2 diabetes, hospital discharge, HbA1c, glargine, basal insulin, oral antidiabetic drugs, hypoglycemia, glycemic control, treatment intensification
- MeSH terms
- Insulin Glargine, Adult, Aged, Algorithms, Blood Glucose, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, Patient Discharge, Prospective Studies, Treatment Outcome, Insulin, Long-Acting
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