Effect of hospital admission on glycemic control 1 year after discharge
To assess the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge. We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values for 6 months before admission and 1 yea...
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| Veröffentlicht in: | Endocrine practice 2012-07, Vol.18 (4), p.456-463 |
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| creator | Wei, Nancy J Grant, Richard W Nathan, David M Wexler, Deborah J |
| description | To assess the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge.
We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values for 6 months before admission and 1 year after discharge. We compared them with 826 nonhospitalized adults with diabetes matched for age, sex, race, comorbidity, and baseline A1C level. We determined the change in A1C value relative to hospitalization and baseline A1C level by using multivariate random effects models for repeated measures. Logistic regression analysis was performed to determine predictors of achieving recommended A1C levels at 1 year.
Patients with baseline A1C levels ≥9% had an adjusted rate of change in A1C value of -0.10% per month (95% confidence interval [CI], -0.18 to -0.022; P=.012) during the course of 1 year, without significant differences between hospitalized and nonhospitalized patients in the mean rate of change. Hospitalized patients, however, were less likely to achieve an A1C goal of ≤7% at 1 year (odds ratio, 0.68; 95% CI, 0.55 to 0.86; P |
| doi_str_mv | 10.4158/ep11309.or |
| format | Article |
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We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values for 6 months before admission and 1 year after discharge. We compared them with 826 nonhospitalized adults with diabetes matched for age, sex, race, comorbidity, and baseline A1C level. We determined the change in A1C value relative to hospitalization and baseline A1C level by using multivariate random effects models for repeated measures. Logistic regression analysis was performed to determine predictors of achieving recommended A1C levels at 1 year.
Patients with baseline A1C levels ≥9% had an adjusted rate of change in A1C value of -0.10% per month (95% confidence interval [CI], -0.18 to -0.022; P=.012) during the course of 1 year, without significant differences between hospitalized and nonhospitalized patients in the mean rate of change. Hospitalized patients, however, were less likely to achieve an A1C goal of ≤7% at 1 year (odds ratio, 0.68; 95% CI, 0.55 to 0.86; P<.001) or an A1C of <8% at 1 year (odds ratio, 0.62; 95% CI, 0.48 to 0.81; P<.001) in comparison with the nonhospitalized patients.
Despite an overall trend toward improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year in comparison with matched nonhospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.</description><identifier>ISSN: 1530-891X</identifier><identifier>EISSN: 1934-2403</identifier><identifier>DOI: 10.4158/ep11309.or</identifier><identifier>PMID: 22805110</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Academic Medical Centers ; Aged ; Boston ; Case-Control Studies ; Cohort Studies ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - therapy ; Female ; Follow-Up Studies ; Glycated Hemoglobin A - analysis ; Hospitalization ; Humans ; Hyperglycemia - prevention & control ; Hypoglycemia - prevention & control ; Male ; Medical Records ; Middle Aged ; Patient Education as Topic ; Primary Health Care ; Retrospective Studies ; Urban Health</subject><ispartof>Endocrine practice, 2012-07, Vol.18 (4), p.456-463</ispartof><rights>Copyright Allen Press Publishing Services Jul/Aug 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-a386839a3d9ffd2414e53579aa93cff2c47583bdbd6d71bf6801218be2de7d203</citedby><cites>FETCH-LOGICAL-c417t-a386839a3d9ffd2414e53579aa93cff2c47583bdbd6d71bf6801218be2de7d203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1700651581?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22805110$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wei, Nancy J</creatorcontrib><creatorcontrib>Grant, Richard W</creatorcontrib><creatorcontrib>Nathan, David M</creatorcontrib><creatorcontrib>Wexler, Deborah J</creatorcontrib><title>Effect of hospital admission on glycemic control 1 year after discharge</title><title>Endocrine practice</title><addtitle>Endocr Pract</addtitle><description>To assess the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge.
We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values for 6 months before admission and 1 year after discharge. We compared them with 826 nonhospitalized adults with diabetes matched for age, sex, race, comorbidity, and baseline A1C level. We determined the change in A1C value relative to hospitalization and baseline A1C level by using multivariate random effects models for repeated measures. Logistic regression analysis was performed to determine predictors of achieving recommended A1C levels at 1 year.
Patients with baseline A1C levels ≥9% had an adjusted rate of change in A1C value of -0.10% per month (95% confidence interval [CI], -0.18 to -0.022; P=.012) during the course of 1 year, without significant differences between hospitalized and nonhospitalized patients in the mean rate of change. Hospitalized patients, however, were less likely to achieve an A1C goal of ≤7% at 1 year (odds ratio, 0.68; 95% CI, 0.55 to 0.86; P<.001) or an A1C of <8% at 1 year (odds ratio, 0.62; 95% CI, 0.48 to 0.81; P<.001) in comparison with the nonhospitalized patients.
Despite an overall trend toward improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year in comparison with matched nonhospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Boston</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hyperglycemia - prevention & control</subject><subject>Hypoglycemia - prevention & control</subject><subject>Male</subject><subject>Medical Records</subject><subject>Middle Aged</subject><subject>Patient Education as Topic</subject><subject>Primary Health Care</subject><subject>Retrospective Studies</subject><subject>Urban Health</subject><issn>1530-891X</issn><issn>1934-2403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkM9LwzAYhoMoTqcX_wAJeBGhM1_SNulRxpzCYCIK3kqaH1tH28ykPey_N7rpQfjg_Q4PLy8PQldAJilk4t5sARgpJs4foTMoWJrQlLDj-GeMJKKAjxE6D2FDCCUFiFM0olSQDICcofnMWqN67Cxeu7Cte9lgqds6hNp1ON6q2SnT1gor1_XeNRjwzkiPpe2Nx7oOai39ylygEyubYC4POUbvj7O36VOyWM6fpw-LRKXA-0QykQtWSKYLazVNITUZy3ghZcGUtVSlPBOs0pXONYfK5oIABVEZqg3XlLAxut33br37HEzoy7hVmaaRnXFDKIEwIjikgkf05h-6cYPv4roSOCF5Ft1BpO72lPIuBG9sufV1K_0uVpXfesvZy4_ecvka4etD5VC1Rv-hvz7ZFyAYdCA</recordid><startdate>201207</startdate><enddate>201207</enddate><creator>Wei, Nancy J</creator><creator>Grant, Richard W</creator><creator>Nathan, David M</creator><creator>Wexler, Deborah J</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201207</creationdate><title>Effect of hospital admission on glycemic control 1 year after discharge</title><author>Wei, Nancy J ; Grant, Richard W ; Nathan, David M ; Wexler, Deborah J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-a386839a3d9ffd2414e53579aa93cff2c47583bdbd6d71bf6801218be2de7d203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Boston</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hyperglycemia - prevention & control</topic><topic>Hypoglycemia - prevention & control</topic><topic>Male</topic><topic>Medical Records</topic><topic>Middle Aged</topic><topic>Patient Education as Topic</topic><topic>Primary Health Care</topic><topic>Retrospective Studies</topic><topic>Urban Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wei, Nancy J</creatorcontrib><creatorcontrib>Grant, Richard W</creatorcontrib><creatorcontrib>Nathan, David M</creatorcontrib><creatorcontrib>Wexler, Deborah J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Endocrine practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wei, Nancy J</au><au>Grant, Richard W</au><au>Nathan, David M</au><au>Wexler, Deborah J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of hospital admission on glycemic control 1 year after discharge</atitle><jtitle>Endocrine practice</jtitle><addtitle>Endocr Pract</addtitle><date>2012-07</date><risdate>2012</risdate><volume>18</volume><issue>4</issue><spage>456</spage><epage>463</epage><pages>456-463</pages><issn>1530-891X</issn><eissn>1934-2403</eissn><abstract>To assess the effect of hospital admission on glycemic control in patients with diabetes up to 1 year after discharge.
We retrospectively studied 826 adults with diabetes admitted to a tertiary care medical center and with available hemoglobin A1c (A1C) values for 6 months before admission and 1 year after discharge. We compared them with 826 nonhospitalized adults with diabetes matched for age, sex, race, comorbidity, and baseline A1C level. We determined the change in A1C value relative to hospitalization and baseline A1C level by using multivariate random effects models for repeated measures. Logistic regression analysis was performed to determine predictors of achieving recommended A1C levels at 1 year.
Patients with baseline A1C levels ≥9% had an adjusted rate of change in A1C value of -0.10% per month (95% confidence interval [CI], -0.18 to -0.022; P=.012) during the course of 1 year, without significant differences between hospitalized and nonhospitalized patients in the mean rate of change. Hospitalized patients, however, were less likely to achieve an A1C goal of ≤7% at 1 year (odds ratio, 0.68; 95% CI, 0.55 to 0.86; P<.001) or an A1C of <8% at 1 year (odds ratio, 0.62; 95% CI, 0.48 to 0.81; P<.001) in comparison with the nonhospitalized patients.
Despite an overall trend toward improved glycemia over time, hospitalized patients with uncontrolled diabetes were less likely to achieve glycemic targets at 1 year in comparison with matched nonhospitalized patients. These results suggest a missed opportunity to improve long-term glycemic control in hospitalized patients with diabetes.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>22805110</pmid><doi>10.4158/ep11309.or</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Academic Medical Centers Aged Boston Case-Control Studies Cohort Studies Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - therapy Female Follow-Up Studies Glycated Hemoglobin A - analysis Hospitalization Humans Hyperglycemia - prevention & control Hypoglycemia - prevention & control Male Medical Records Middle Aged Patient Education as Topic Primary Health Care Retrospective Studies Urban Health |
| title | Effect of hospital admission on glycemic control 1 year after discharge |
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