Changes in insulin requirements after hospital discharge in insulin-treated patients with type 2 diabetes (T2D) are not known. We conducted a pooled analysis of 4 randomized clinical trials with 3-month follow-up data to determine changes in insulin requirement after discharge. These studies followed a discharge algorithm based on admission HbA1c to guide outpatient insulin therapy. A total of 255 insulin-treated patients (age: 55.6 year, BMI 34.6 kg/m2, duration DM: 11.2±8 year) were discharged on glargine + oral antidiabetic (OAD) agents (75%), glargine + exenatide (4%), or basal bolus (21%). Patients with HbA1c <7% (11.4%) were discharged on the same outpatient therapy. Those with an HbA1c between 7% and 9% (37.2%) were discharged on glargine at 50% of hospital TDD + their outpatient OAD agents. Those with an HbA1c >9% (51.4%) were discharged on glargine at 80% of hospital TDD in combination to OAD or with basal bolus regimen. Treatment was adjusted to achieve a target HbA1c level <7%. The primary outcome was change in insulin total daily dose (TDD) at 3 months after discharge. Changes in HbA1c, hypoglycemia, insulin TDD, and change in insulin requirements at 3 months of follow-up are shown in Table.
In summary, insulin TDD requirements vary greatly after hospital discharge in patients with T2D. Most patients required frequent insulin adjustments to maintain glycemic control and to avoid hypoglycemia after hospital discharge.
M. Fayfman: None. D. LeRoith: Advisory Panel; Self; AstraZeneca, MannKind Corporation. F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. I. Anzola: None. M.A. Urrutia: None. H. Wang: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck 0026 Co., Inc., Novo Nordisk Inc., Sanofi US.