Efficacy and feasibility of basal-bolus insulin regimens and a discharge-strategy in hospitalised patients with type 2 diabetes-the HOSMIDIA study
Pérez Pérez, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Reales, P. (Hospital Gutierrez Ortega)
Barahona, María-José (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Romero, M.G. (Sanofi-Aventis (Barcelona))
Miñambres, Inka (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2014
Resum:	Aims Guidelines recommend use of basal-bolus insulin in hospitalised patients with hyperglycaemia, but information about implementation and medication reconciliation at discharge is scarce. The HOSMIDIA study evaluated a management program involving basal-bolus insulin and an algorithm for medication reconciliation at discharge in non-critically ill hospitalised patients with type 2 diabetes in clinical practice. Methods HOSMIDIA was a prospective, observational study performed during routine clinical practice at 15 Spanish hospitals during hospitalisation, with follow-up 3 months postdischarge. Study patients (n = 134) received a basal-bolus regimen with insulin glargine during hospitalisation and treatment at discharge was adjusted according to a simple algorithm. The control group (n = 62) included patients with similar characteristics hospitalised during the month before study initiation and had no follow-up after discharge. Results Compared with control subjects, patients in the prospective study achieved lower mean total (167. 7 ± 41. 1 vs. 190. 5 ± 53. 3 mg/dl) preprandial (164. 2 ± 42. 4 vs. 189. 6 ± 52. 6 mg/dl; p < 0. 001) and fasting (137. 0 ± 42. 2 vs. 165. 8 ± 56. 5 mg/dl) blood glucose levels while hospitalised, without increased hypoglycaemic episodes (17. 7% vs. 19. 3% patients). In the prospective study, glycaemic control improved from admission to discharge, with control maintained 3 months after discharge. The main treatment modification at discharge compared with admission was addition of basal insulin, and treatment at discharge was maintained at 3 months in 89% of patients. Conclusion The HOSMIDIA study confirmed that management of hyperglycaemia with basal-bolus insulin is feasible and effective in routine clinical practice, and that a simple strategy facilitating the reconciliation of medication on discharge can improve glycaemic control postdischarge.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aged ; Aged, 80 and over ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Drug Administration Schedule ; Female ; Humans ; Hyperglycemia ; Hypoglycemic Agents ; Insulin ; Male ; Middle Aged ; Patient Discharge ; Prospective Studies ; Treatment Outcome
Publicat a:	International Journal of Clinical Practice, Vol. 68 Núm. 10 (january 2014) , p. 1264-1271, ISSN 1742-1241

DOI: 10.1111/ijcp.12498
PMID: 25269951

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