Overcoming missed opportunities in diabetes management to improve outcomes for hospitalized patients with diabetes
Autor: | Robert Woods, Michelle Cudnik, James K. Salem, Megan Elavsky, Jason Kunz, Michael J Oravec, Lynn Clough |
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Rok vydání: | 2017 |
Předmět: |
Blood Glucose
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism MEDLINE 030209 endocrinology & metabolism Logistic regression Cohort Studies 03 medical and health sciences 0302 clinical medicine Endocrinology Diabetes management Diabetes mellitus Bayesian multivariate linear regression Internal Medicine medicine Humans 030212 general & internal medicine Glycemic Aged Retrospective Studies Glycated Hemoglobin business.industry Retrospective cohort study General Medicine Middle Aged medicine.disease Hospitalization Treatment Outcome Diabetes Mellitus Type 2 Emergency medicine Female business Cohort study |
Zdroj: | Diabetes research and clinical practice. 142 |
ISSN: | 1872-8227 |
Popis: | The purpose of this study is to assess the impact of hospitalization on 6-12 month medication adjustment and glycemic control.We conducted a retrospective cohort study of hospitalized and non-hospitalized patients with diabetes of an internal medicine residency continuity clinic. Patients had baseline and outcome HbA1c taken 6-12 months apart. Multivariate linear regression was used to model predictors of HbA1c change from baseline to outcome. Multivariate logistic regression was used to model predictors of medication adjustment between baseline and outcome clinic visits.Hospitalization was not a significant predictor of HbA1c change. Hospitalized patients with baseline HbA1c 7% were more likely to have therapy adjusted (OR 3.05, p = .004), but this trend did not extend to adjustment in patients with baseline HbA1c ≥ 7% (OR 0.98, p = .249). A significant predictor of medication adjustment was having a specialized Chronic Care Model-based outpatient diabetic planned visit (DPV) (OR 1.63, p = .020). Depression was not a significant predictor for medication therapy change in well-controlled patients with diabetes, but was associated with a lower likelihood for medication adjustment in poorly-controlled patients with diabetes (OR 0.47, p = .004).Our study supports previous research in that hospitalization may be seen as a "missed opportunity" to intensify treatment when indicated. Based on our findings, hospitalized patients may benefit from enhanced focus on outpatient follow-up. A next step for research is to assess efficacy of scheduling a DPV proximate to discharge for HbA1c reduction when diabetes is poorly controlled. |
Databáze: | OpenAIRE |
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