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Type 2 Diabetes Treatment and Experience With Hospitalization in Older Adults: A Convergent Mixed-Methods Study
Steven P Masiano1,2, Valerie Chepp1,2, Larisa G Tereshchenko1,2,3
1Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH.
Objective:
To explore changes in type 2 diabetes treatment during hospitalization, understand the experiences of providers and patients in managing type 2 diabetes related to hospitalization, and assess type 2 diabetes control postdischarge.
Research Design And Methods:
A convergent mixed methods study used electronic medical record and included a retrospective cohort of adults ≥65 years of age with uncontrolled type 2 diabetes discharged from 11 U.S. hospitals between November 2022 and April 2023. Type 2 diabetes treatment changes included changing diabetes medications or adjusting doses during hospitalization or up to 30 days postdischarge, or completing consults to endocrinology, diabetes education, or nutrition. Type 2 diabetes control was defined as having glycosylated hemoglobin (A1C) <8% at 6 months postdischarge. Logistic regression models assessed the association of treatment change with type 2 diabetes control. Thirty-one semistructured interviews were conducted with a subset of patients (n = 15) and providers (n = 16), with thematic analysis performed.
Results:
The cohort included 358 patients, with a mean (SD) age of 74 (±7) years, 61% White, 95% non-Hispanic, and 51% female. Medication changes occurred in 61% (218 of 358) of patients, and 42% (150 of 358) completed consultations. Type 2 diabetes control was higher in patients with medication changes (versus not) (51% vs. 25%, P = 0.02; unadjusted odds ratio 3.17 [95% CI 1.17, 8.54]) or completed endocrinology consults (versus not) (unadjusted odds ratio 3.31 [95% CI 1.11, 9.97]). Most patients and providers supported type 2 diabetes treatment changes during or soon after hospitalization; however, some reported hesitancy, and opportunities for diabetes education were missed.
Conclusions:
Hospitalization period presents a unique opportunity to treat uncontrolled type 2 diabetes.
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