Endocrine Abstracts

Objective: To evaluate the characteristics and glycemic control in admitted patients with type 2 diabetes and high vascular risk. To analyze therapeutic switch effect at hospital discharge on medium term metabolic control.

Methods: Cross-sectional study including patients with type 2 diabetes and high vascular risk. Demographic and clinical characteristics, laboratory parameters, and diabetes treatment at baseline and discharge were analized. We used a specific insulin protocol during admission, switched treatment at discharge in selected cases and evaluated the metabolic control evolution 3 months after discharge.

Results: 126 patients were included (55.6% male, mean age 64.3 years and mean duration of diabetes 16.3 years). 63.5% had hypertension, 47.6% dyslipidemia and 19% were smokers. 7.1% had a history of stroke, 40.5% coronary heart disease and 36.5% peripheral arteriopathy. Most prevalent causes of admissions: 22.2% amputation, 17.5% coronary bypass, 15.9% valve surgery and 15.1% coronary heart disease. Prior to admission, 38.9% were treated with insulin, 30.2% with oral hypoglycemic agents (OHA) and 25.4% with combinated therapy. At discharge, 45.2% remained their previous treatment, adjusted if necessary and 43.5% started insulin treatment (8.7% basal insulin plus OHA, 7.1% basal insulin, 11.9% biphasic insulins, and 15.9% basal-bolus regimen). Mean HbA1c at admission decreased from 8.9% (18.6% patients, <7%) to 7.49%, (44.2% patients <7%) (P<0.001) 3 months after discharge, with no significant differences detected in the rest of variables analized.

Conclusions: Most hospitalized patients with type 2 diabetes presented with poor glycemic control and chronic complications. Insulin consensus protocol can improve glycemic control during hospitalization. Optimizing therapy at discharge improves medium term metabolic control.