Patterns and predictors of antihyperglycemic intensification at hospital discharge for type 2 diabetic patients not on home insulin

BACKGROUND: Diabetes mellitus is a prevalent condition among hospitalized patients and the inpatient setting presents an opportunity for providers to review and adjust antihyperglycemic medications. We sought to describe practice patterns and predictors of antihyperglycemic intensification (AHI) at hospital discharge for type 2 diabetes mellitus (T2DM) patients not on home insulin. METHODS: We conducted a retrospective study of adult patients with T2DM receiving either non-insulin antihyperglycemic (NIA) or no antihyperglycemic medications prior to admission who were hospitalized within two hospitals in the Johns Hopkins Health System from December 2015 to September 2016. Mean hospital glucose values and observed vs. individualized target hemoglobin A1C values (based on risk of mortality score) were used to define an indication for AHI. Multivariable logistic regression was used to identify predictors of AHI. RESULTS: A total of 554 discharges of 475 unique patients were included. An indication for AHI was present in 104 (18.8%) of discharges, and AHI occurred in 30 (28.8%) of these discharges. Higher mean admission BG values and A1C, fewer pre-admission antihyperglycemic agents, involvement of the diabetes service, and admitting service were associated with AHI, while no association was observed with age, sex, race, risk of mortality and severity of illness scores, or length of stay. AHI was not associated with 30-day readmission. CONCLUSION: An indication for AHI occurs relatively infrequently among hospitalized patients, but when present, AHI occurs in approximately 1 in 3 discharges. AHI appears to be related largely to the degree of hyperglycemia, and diabetes service involvement. Further studies are needed to understand the implications of AHI at hospital discharge on short and long-term outcomes in this population.