Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm

Abstract EN

Type 2 diabetes (T2D) exists in 25–40% of hospitalized patients.

Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D.

The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge.

A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D.

Their preadmittance HbA 1c was 7.7 ± 1.5%; 47% (189) had HbA 1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge.

Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA 1c .

Ninety-four of the 189 SCGC patients were evaluated 3–6 months later.

Their HbA 1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up ( P < 0.004 ).

Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases.

A shift to the upper step in the therapeutic algorithm at discharge improves this control.

Hospitalization is an opportunity to break therapeutic inertia.