Hospital Discharge Algorithm Based on Admission HbA1c for the Management of Patients With Type 2 Diabetes
Hospital Discharge Algorithm Based on Admission HbA1c for the Management of Patients With Type 2 Diabetes
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DOI：
10.2337/dc14-0479
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发表时间：
2014-11-01
期刊：
影响因子：
16.2
通讯作者：
Fonseca, Vivian
中科院分区：
文献类型：
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作者：
Umpierrez, Guillermo E.;Reyes, David;Fonseca, Vivian
有效的治疗算法是必要的，以指导糖尿病护理在医院出院的一般内科和外科2型diabetes.RESEARCH设计和METHODSThis患者是一个前瞻性的，多中心的开放标签研究，旨在确定安全性和有效性的基础上入院HbA（1C）出院算法。HbA（1c）< 7%的患者（53.0mmol/mol），HbA（1c）在7 ~ 9%之间（53.0-74.9 mmol/mol）出院时接受入院前方案加甘精胰岛素，剂量为住院日剂量的50%，HbA（1c）> 9%的患者出院后接受口服降糖药（OAD）加甘精胰岛素或基础餐时方案（80%的住院剂量）治疗。主要结局是出院后12周时的HbA（1c）浓度。共有224例患者出院时接受OAD（36%）、OAD和甘精胰岛素联合治疗（27%）、基础餐时胰岛素（24%）、甘精胰岛素单药治疗（9%）和饮食（4%）治疗。入院时HbA（1c）为8.7 +/- 2.5%（71.6 mmol/mol），在12周随访时降至7.3 +/- 1.5%（56 mmol/mol）（P < 0.001）。HbA（1c）<7%、7- 9%和> 9%的患者出院后12周HbA（1c）较基线的变化分别为-0.1 +/- 0.6、-0.8 +/- 1.0和-3.2 +/- 2.4（P < 0.001）。低血糖在出院时仅接受OAD治疗的患者中，22%的患者报告了HbA（1c）< 70 mg/dL，OAD+甘精胰岛素组为30%，基础餐时胰岛素组为44%，甘精胰岛素单药组为25%，入院时HbA（1c）<7%的患者相似（百分之三十一，P = 0.54）.结论HbA（1c）的测定在入院时，有利于在普通内科和外科2型糖尿病患者出院时制定治疗方案。
OBJECTIVEEffective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes.RESEARCH DESIGN AND METHODSThis was a prospective, multicenter open-label study aimed to determine the safety and efficacy of a hospital discharge algorithm based on admission HbA(1c). Patients with HbA(1c) < 7% (53.0mmol/mol) were discharged on their preadmission diabetes therapy, HbA(1c) 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 HbA(1c) > 9% were discharged on oral antidiabetes agents (OADs) plus glargine or basal bolus regimen at 80% of inpatient dose. The primary outcome was HbA(1c) concentration at 12 weeks after hospital discharge.RESULTSA 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 HbA(1c) 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 HbA(1c) from baseline at 12 weeks after discharge was -0.1 +/- 0.6, -0.8 +/- 1.0, and -3.2 +/- 2.4 in patients with HbA(1c) < 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 HbA(1c) 7% (31%, P = 0.54).CONCLUSIONSMeasurement of HbA(1c) on admission is beneficial in tailoring treatment regimens at discharge in general medicine and surgery patients with type 2 diabetes.