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Published on: June 11, 2012
Characterization of Antidiabetic Medication Prescribing After Hospital Discharge in US Critically Ill Adults
Ting-Ting Wu1, Judi Jacobi2, Caroline Cullen3
1Department of Public Health and Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
Background:
Critical illness-associated hyperglycemia is common and frequently results in new antidiabetic agent (ADA) initiation. However, new ADA use after an intensive care unit (ICU) hospitalization remains poorly characterized.
Objective:
To describe ADA prescribing in the 2 months after an ICU hospitalization in American adults (ADA-naïve prior to ICU admission) and the factors associated with this prescribing.
Methods:
This retrospective cohort study analyzed data from the US insurance claims database PharMetrics Plus for Academics (P+) for adults admitted to an ICU requiring mechanical ventilation during 2021 who were discharged directly to home. Patients with an ICU hospitalization in the prior 2 months or admitted with diabetic ketoacidosis or a hyperosmolar hyperglycemia state were excluded. The primary outcome was the proportion of ADA-naïve patients prescribed ≥1 ADA in the 2 months after discharge. Age, diabetes mellitus (DM) history, baseline Diabetes Comorbidity Index, Charlson Comorbidity Index, Hospital Frailty Risk Score, and medical (vs surgical) admission were entered into a multivariable logistic regression to identify factors associated with this prescribing.
Results:
Among the 28 798 817 patients in the P+ database in 2021, 2733 met study criteria. Among the 2346 (87.3%) who were ADA-naïve, 100 (4.2%) were prescribed ≥1 ADA in the 2 months after hospitalization. Most (88/100, 88%) were prescribed only 1 ADA; a biguanide (39%) or insulin (29%) was most common. A diagnosis of DM was similar 2 months before-and-after ICU hospitalization. Pre-existing DM (adjusted odds ratio [aOR] [95% CI]) was associated with greater new ADA prescribing (4.90 [2.91-8.19]), while age (0.99 [0.97-1.00]) and frailty (0.96 [0.93-0.99]) were associated with less new ADA prescribing.
Conclusions And Relevance:
Newly prescribed ADA therapy after an ICU hospitalization in critically ill adults who are discharged to a home setting is rare but more common in patients having a diagnosis of DM prior to ICU admission.
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