Indicator performance after the implementation of the Spanish Consensus Document for the control of hyperglycemia in the hospital and at discharge

Background and aims: Information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization.

Methods: Observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA_1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge.

Results: 199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA_1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA_1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups.

Conclusions: Implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge.