Endocrine Abstracts

Background: Basal-Bolus (BB) insulin treatment is increasingly used in uncontrolled diabetes patients during hospitalization and is commonly recommended on their discharge. However, the extent of adherence with this recommendation is unknown.

Aim: To determine the short term adherence of type 2 diabetes mellitus (T2DM) patients discharged from internal medicine wards with recommendation for BB insulin treatment.

Methods: Prescription (primary-physician adherence) and purchase (patient-adherence) of long acting and short acting insulins during the 1st month following discharge from internal medicine wards was determined in 336 T2DM patients. Adherence was defined as “full” if prescription/purchase of both basal (long acting) and bolus (short acting) insulin was made and as “partial” if only one kind of insulin was prescribed/purchased. Association between demographic and clinical parameters and adherence was determined.

Results: Primary-physicians’ full adherence with discharge instructions was higher than patients’ full adherence)76% vs. 62.2% respectively, P=0.01). Pre-hospitalization HbA1c was significantly associated with both patient’s and physicians’ adherence (9.0%±2.1% in the full adherence group and 7.7%±1.3% in the no adherence group, P<0.01). Age was negatively associated with adherence of primary-physicians (73±11.2 years in the full adherence group and 65.4±15.5 years in the no adherence group, P<0.01). A negative correlation between patients and physicians’ adherence and Length of hospitalization was found. When the sole cause of admission was diabetes, close to 100% adherence of both primary-physicians and patients was found.

Conclusion: Short term adherence with discharge recommendation for BB insulin treatment is associated with pre-hospitalization patient characteristics and length of hospitalization