1111-P: Predictors of Type 2 Diabetes (T2D) Medication Change and Improved A1C among Older Adults Post-hospitalization
Authors: MASIANO STEVEN P. , TERESHCHENKO LARISA G. , CHEPP VALERIE , MILINOVICH ALEX , FOX JACQUELINE , PANTALONE KEVIN M. , MISRA-HEBERT ANITA D. 
Published: June 2024

Introduction & Objective: The hospitalization period may be an opportunity for providers to initiate treatment changes for patients with uncontrolled T2D. We examined factors associated with medication changes and improved A1c levels among older adults with T2D after hospitalization.

Methods: This retrospective cohort study utilized electronic medical records of patients ≥65 years old with T2D and A1c ≥8% discharged to home from 11 Cleveland Clinic Health System hospitals from 11/2022-04/2023. Medication change was defined as a change in medication regimen or daily dosage post-hospitalization. Improved A1c level was defined as A1c &lt;8% at 180 days post-discharge in a subsample of patients with medication change and for whom the change preceded A1c testing. Predictors of medication change and A1c &lt;8% post-hospitalization were modeled using logistic regressions.

Results: The cohort included 359 patients, mean (SD) age 74 (±7) y, 61% White, 95% non-Hispanic, 51% female, 48% married, and 85% had Medicare. All patients were followed for six months. Treatment changes occurred in 65% of patients within 30 days and 82% within 90 days from discharge, with mean days to treatment change as 31 (95%CI: 26, 35). Patients with higher A1c values pre-hospitalization, A1c tests during hospitalization, and higher readmission risk were more likely to have medication changes. A1c data was available in N=289 (81%) patients at 6 months. The proportion achieving A1c &lt;8% at 180 days was 42% (121/289) but significantly higher among those who had treatment change within 30 days (51% vs. 14%, p=0.003; OR=3.22, 95%CI: 1.01,10.21). Lower A1c value pre-hospitalization and A1c testing during hospitalization were also associated with A1c &lt;8%.

Conclusion: A1c testing during hospitalization was an important predictor for treatment change and improved A1c levels in older patients with T2D with A1c &lt;u&gt;&gt;&lt;/u&gt;8%. Recognition of the hospitalization period as an opportunity to address high A1c levels is thus crucial.

Disclosure

S.P. Masiano: None. L.G. Tereshchenko: None. V. Chepp: None. A. Milinovich: Research Support; Novo Nordisk, Bayer Inc., Merck & Co., Inc., Twin Health, National Institutes of Health, Eli Lilly and Company, Pfizer Inc. J. Fox: None. K.M. Pantalone: Speaker's Bureau; AstraZeneca. Consultant; AstraZeneca. Board Member; Bayer Inc. Research Support; Bayer Inc. Speaker's Bureau; Corcept Therapeutics. Consultant; Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc. Speaker's Bureau; Merck & Co., Inc. Research Support; Merck & Co., Inc. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Twin Health. Consultant; Sanofi. A.D. Misra-Hebert: Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk.

Funding

This work was internally supported with funding from the Healthcare Delivery and Implementation Science Center at Cleveland Clinic.