Determining insulin dose at the time of discharge in a high-risk population: Is there room for improvement?

David Carruthers, Mehwish Ismaily, Anna Vanderheiden, Mariana Yates, Amy DeGueme, Beverley A Huet, Samata Basani, Marconi Abreu, Ildiko Lingvay

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the adequacy of the insulin dose prescribed at hospital discharge in a high-risk population and assess patient characteristics that influence insulin dose requirement in the immediate postdischarge period. Methods: This was a retrospective study conducted at Parkland Health System. We included all patients admitted to a medical floor who received an insulin prescription at discharge and had at least one follow-up visit within 6 months of discharge. All data were extracted by a detailed manual review of each electronic medical record. Results: At the postdischarge follow-up (N = 797, median 33 days from discharge), 60% of patients required an insulin dose adjustment; 47% of the patients required a dose decrease. Significant predictors of a decrease insulin requirement postdischarge included (multiple regression beta coefficient [95% confidence interval]): newly diagnosed diabetes, −12.7 (−17.7, −7.7); ketosis-prone diabetes, −8.4 (−15, −1.8); glycated hemoglobin A1c (HbA1c), <10% (86 mmol/mol) −7.0 (−11.4, −2.6); discharge insulin total daily dose, −5.3 (−9.3, −1.3); and metformin prescription, −4.9 (−8.4, −1.3). Conclusion: An insulin dose adjustment (most commonly a decrease) was necessary shortly after discharge in more than half of our patients. A better model to estimate insulin dose at discharge is needed along with short-term follow-up after discharge for insulin titration. A pre-emptive insulin dose reduction at discharge should be considered for patients with newly diagnosed diabetes, ketosis-prone diabetes, metformin prescription, and those with HbA1c <10% at presentation.

Original languageEnglish (US)
Pages (from-to)263-269
Number of pages7
JournalEndocrine Practice
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2019

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Insulin
Population
Prescriptions
Ketosis
Metformin
Patient Discharge
Electronic Health Records
Glycosylated Hemoglobin A
Hemoglobins
Retrospective Studies
Confidence Intervals
Health

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Determining insulin dose at the time of discharge in a high-risk population : Is there room for improvement? / Carruthers, David; Ismaily, Mehwish; Vanderheiden, Anna; Yates, Mariana; DeGueme, Amy; Huet, Beverley A; Basani, Samata; Abreu, Marconi; Lingvay, Ildiko.

In: Endocrine Practice, Vol. 25, No. 3, 01.03.2019, p. 263-269.

Research output: Contribution to journalArticle

Carruthers, D, Ismaily, M, Vanderheiden, A, Yates, M, DeGueme, A, Huet, BA, Basani, S, Abreu, M & Lingvay, I 2019, 'Determining insulin dose at the time of discharge in a high-risk population: Is there room for improvement?', Endocrine Practice, vol. 25, no. 3, pp. 263-269. https://doi.org/10.4158/EP-2018-0434
Carruthers, David ; Ismaily, Mehwish ; Vanderheiden, Anna ; Yates, Mariana ; DeGueme, Amy ; Huet, Beverley A ; Basani, Samata ; Abreu, Marconi ; Lingvay, Ildiko. / Determining insulin dose at the time of discharge in a high-risk population : Is there room for improvement?. In: Endocrine Practice. 2019 ; Vol. 25, No. 3. pp. 263-269.
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abstract = "Objective: To evaluate the adequacy of the insulin dose prescribed at hospital discharge in a high-risk population and assess patient characteristics that influence insulin dose requirement in the immediate postdischarge period. Methods: This was a retrospective study conducted at Parkland Health System. We included all patients admitted to a medical floor who received an insulin prescription at discharge and had at least one follow-up visit within 6 months of discharge. All data were extracted by a detailed manual review of each electronic medical record. Results: At the postdischarge follow-up (N = 797, median 33 days from discharge), 60{\%} of patients required an insulin dose adjustment; 47{\%} of the patients required a dose decrease. Significant predictors of a decrease insulin requirement postdischarge included (multiple regression beta coefficient [95{\%} confidence interval]): newly diagnosed diabetes, −12.7 (−17.7, −7.7); ketosis-prone diabetes, −8.4 (−15, −1.8); glycated hemoglobin A1c (HbA1c), <10{\%} (86 mmol/mol) −7.0 (−11.4, −2.6); discharge insulin total daily dose, −5.3 (−9.3, −1.3); and metformin prescription, −4.9 (−8.4, −1.3). Conclusion: An insulin dose adjustment (most commonly a decrease) was necessary shortly after discharge in more than half of our patients. A better model to estimate insulin dose at discharge is needed along with short-term follow-up after discharge for insulin titration. A pre-emptive insulin dose reduction at discharge should be considered for patients with newly diagnosed diabetes, ketosis-prone diabetes, metformin prescription, and those with HbA1c <10{\%} at presentation.",
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AU - Carruthers, David

AU - Ismaily, Mehwish

AU - Vanderheiden, Anna

AU - Yates, Mariana

AU - DeGueme, Amy

AU - Huet, Beverley A

AU - Basani, Samata

AU - Abreu, Marconi

AU - Lingvay, Ildiko

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N2 - Objective: To evaluate the adequacy of the insulin dose prescribed at hospital discharge in a high-risk population and assess patient characteristics that influence insulin dose requirement in the immediate postdischarge period. Methods: This was a retrospective study conducted at Parkland Health System. We included all patients admitted to a medical floor who received an insulin prescription at discharge and had at least one follow-up visit within 6 months of discharge. All data were extracted by a detailed manual review of each electronic medical record. Results: At the postdischarge follow-up (N = 797, median 33 days from discharge), 60% of patients required an insulin dose adjustment; 47% of the patients required a dose decrease. Significant predictors of a decrease insulin requirement postdischarge included (multiple regression beta coefficient [95% confidence interval]): newly diagnosed diabetes, −12.7 (−17.7, −7.7); ketosis-prone diabetes, −8.4 (−15, −1.8); glycated hemoglobin A1c (HbA1c), <10% (86 mmol/mol) −7.0 (−11.4, −2.6); discharge insulin total daily dose, −5.3 (−9.3, −1.3); and metformin prescription, −4.9 (−8.4, −1.3). Conclusion: An insulin dose adjustment (most commonly a decrease) was necessary shortly after discharge in more than half of our patients. A better model to estimate insulin dose at discharge is needed along with short-term follow-up after discharge for insulin titration. A pre-emptive insulin dose reduction at discharge should be considered for patients with newly diagnosed diabetes, ketosis-prone diabetes, metformin prescription, and those with HbA1c <10% at presentation.

AB - Objective: To evaluate the adequacy of the insulin dose prescribed at hospital discharge in a high-risk population and assess patient characteristics that influence insulin dose requirement in the immediate postdischarge period. Methods: This was a retrospective study conducted at Parkland Health System. We included all patients admitted to a medical floor who received an insulin prescription at discharge and had at least one follow-up visit within 6 months of discharge. All data were extracted by a detailed manual review of each electronic medical record. Results: At the postdischarge follow-up (N = 797, median 33 days from discharge), 60% of patients required an insulin dose adjustment; 47% of the patients required a dose decrease. Significant predictors of a decrease insulin requirement postdischarge included (multiple regression beta coefficient [95% confidence interval]): newly diagnosed diabetes, −12.7 (−17.7, −7.7); ketosis-prone diabetes, −8.4 (−15, −1.8); glycated hemoglobin A1c (HbA1c), <10% (86 mmol/mol) −7.0 (−11.4, −2.6); discharge insulin total daily dose, −5.3 (−9.3, −1.3); and metformin prescription, −4.9 (−8.4, −1.3). Conclusion: An insulin dose adjustment (most commonly a decrease) was necessary shortly after discharge in more than half of our patients. A better model to estimate insulin dose at discharge is needed along with short-term follow-up after discharge for insulin titration. A pre-emptive insulin dose reduction at discharge should be considered for patients with newly diagnosed diabetes, ketosis-prone diabetes, metformin prescription, and those with HbA1c <10% at presentation.

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