Overcoming missed opportunities in diabetes management to improve outcomes for hospitalized patients with diabetes

Aims: The purpose of this study is to assess the impact of hospitalization on 6-12 month medication adjustment and glycemic control. Methods: 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. Results: 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). Discussion: 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. (C) 2018 Elsevier B.V. All rights reserved.