Transition-of-Care Algorithm Performs Well in Surgery Patients With Type 2 Diabetes

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Mild hypoglycemia rates were lower among patients with HbA1c <7% compared with those with HbA1c between 7% and 9%.
Mild hypoglycemia rates were lower among patients with HbA1c <7% compared with those with HbA1c between 7% and 9%.

This article is part of Endocrinology Advisor's coverage of the American Diabetes Association's 77th Scientific Sessions (ADA 2017), taking place in San Diego, CA. Our staff will report on medical research and technological advances in diabetes and diabetes education, conducted by experts in the field. Check back regularly for more news from ADA 2017.


A hemoglobin A1c (HbA1c)-based algorithm was safe and efficacious for transitioning of care in general surgery patients with type 2 diabetes, according to results presented at the American Diabetes Association's (ADA) 77th Scientific Sessions, held June 9-13 in San Diego, California.

“We have shown that using a simplified HbA1c-based algorithm is safe and effective in improving glycemic control in surgery patients with type 2 diabetes after discharge from the hospital,” study investigator Neda Rasouli, MD, of the University of Colorado School of Medicine, Aurora, said in an interview.

 

Dr Rasouli explained that at present, data are limited on the optimal transition of diabetes care in general surgery patients with type 2 diabetes.

“It is a common practice to focus on the care for acute problems during hospitalization, and transition of care for diabetes has not been studied,” she said. “We identified this gap in knowledge and examined the efficacy and safety of an HbA1c-based algorithm in this population.”

The study included 224 surgery patients with type 2 diabetes. Mean patient age was 57±11 years; body mass index was 34±8 kg/m2; and duration of type 2 diabetes was 8.5±8 years.

Patients who were receiving incretin-based therapy or insulin >0.5 units/kg before hospitalization were excluded from the study.

According to study background, the algorithm recommended the following:

  • Initiating linagliptin 5 mg/d for drug-naive patients or continuing home regimen for patients with HbA1c <7%.
  • Adding linagliptin to home regimen of oral antidiabetic agents plus insulin glargine at 50% of the inpatient dose for HbA1c between 7% and 9%.
  • Adding linagliptin to home regimen of oral antidiabetic agents plus glargine at 80% of the inpatient dose for HbA1c >9%.

The researchers altered treatment to achieve a target HbA1c <7%.

At admission, the mean HbA1c was 6.4%±0.4% for patients with HbA1c <7% (n=92); 7.8%±0.6% for patients with HbA1c between 7% and 9% (n=93); and 11.4%±2.1% for patients with HbA1c >9% (n=39).

Overall, HbA1c fell from 7.9%±2% at admission to 7.1%±1.5% at 3 months after discharge (P <.001). Results by subgroup indicated that HbA1c remained the same in the HbA1c <7% group, but decreased by 0.8%±0.9% in the HbA1c 7% to 9% group and 3.2±2.5% in the HbA1c >9% group (P for both <.001).

Rates of mild hypoglycemia (blood glucose, <70 mg/dL) were lower among patients with HbA1c <7% (10%) compared with those with HbA1c between 7% and 9% (19%) and >9% (31%; P =.03).

In other data, only 2 patients experienced a blood glucose <40 mg/dL, 1 of whom was in the HbA1c <7% group and the other was in the HbA1c >9% group. The rate of severe hyperglycemia (blood glucose, >300 mg/dL) did not significantly differ between groups (P = .12), nor did HbA1c and the rate of hypoglycemia in patients treated with linagliptin vs comparators.

“We propose that hospitalization can be used as an opportunity to improve diabetes care,” Dr Rasouli concluded. “It will potentially reduce the rate of complications post discharge as well as long-term complications of diabetes.”

Dr Rasouli said she and her colleagues also propose that implementing an algorithm-based transition of care for patients with diabetes is feasible and safe, and will improve long-term glycemic control after discharge.


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Reference

Rasouli N, Vellanki P, Alexanian S, et al. Transition of diabetes care in surgery patients with type 2 diabetes (T2D) using an HbA1c-based algorithm. Late Breaking Poster 166. Presented at: American Diabetes Association's (ADA) 77th Scientific Sessions June 9-13, 2017; San Diego, CA. 

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