Pharmacoepidemiol Risk Manage.  2024 Mar;16(1):40-48. 10.56142/perm.24.0002.

Diabetes Medication Intensifications at Discharge in Older Adults: Prevalence and Impact on Short-Term Clinical Outcomes

• Han JH
• Jung AH
• Kim M
• Jung SH
• Lee JY

• KMID: 2556391
• DOI: http://doi.org/10.56142/perm.24.0002

Abstract

Objective
This study aimed to assess diabetes medication intensification at discharge in older adults hospitalized for non-glycemic reasons, examining its shortterm benefits and risks.
Methods
A retrospective review of electronic medical records from Boramae Medical Center (September 1, 2020, to August 31, 2022) was conducted. Medication intensification was defined as either increasing the dosage of existing diabetes medications, adding insulin or initiating new medications. We compared glycated hemoglobin (HbA1c) levels 90 days post-discharge and the incidence of blood glucose-related emergency department visits or diabetesrelated unplanned readmission within 90 days post-discharge between patients with and without medication intensification.
Results
Out of 1,278 patients, 480 (37.6%) underwent medication intensification at discharge. Factors associated with intensification included longer hospital stays, consultations with endocrinologist, higher HbA1c at admission, frequent hyperglycemic events, and changes in steroid or immunosuppressant use. The intensification group showed a significant reduction (8.6% to 7.0%) in HbA1c 90 days post-discharge compared to the non-intensification group (6.9% to 6.9%, p < 0.001). However, there was no significant impact on postdischarge emergency visits or unplanned readmissions related to blood glucose (aOR 0.34; 95% CI 0.07–1.53).
Conclusion
A third of older adults admitted for nonglycemic issues was discharged with intensified diabetes medications, leading to improved short-term glycemic control but did not significantly affect diabetesrelated unplanned readmissions or emergency visits.

Keyword

Diabetes mellitus; Hypoglycemic agent; Patient discharge; Aged; Blood glucose; Glycated hemoglobin