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Adjustment of antidiabetic treatment regimens on discharge from the emergency department: effect on 90-day outcomes in patients admitted to a short-stay unit

Cuervo Pinto R, Hernández López S, Aguirre Juaristi N, Chaparro Pardo D, González Armengol JJ, Martín-Sánchez FJ

Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.

Objective. To determine whether the adjustment of antidiabetic treatment of patients discharged from a short-stay unit (SSU) after a hyperglycemic crisis reduces the rate of adverse events in the next 90 days.
Methods. Retrospective study of patients admitted to an emergency SSU in June 2011. We gathered information on patient demographics, concurrent diseases, reason for admission, and appropriateness of antidiabetic treatment on discharge. Patients were classified as diabetic, nondiabetic, or newly hyperglycemic. Patients with altered carbohydrate
metabolism were subclassified according to the appropriateness of the antidiabetic treatment prescribed on discharge. The main outcome variable was the occurrence of an adverse event within 90 days of discharge.
Results. We included 750 patients with a mean (SD) age of 68.1 (19.5) years; 357 (47.6%) were men. A new adverse event occurred in 262 (36%) patients within 90 days; 15.6 (31.5%) of these patients were not diabetic, 77 (41.8%) were diabetic, and 29 (59.2%) were newly hyperglycemic (P<.001). Failure to provide an appropriate antidiabetic regimen when discharging patients with altered carbohydrate metabolism was an independent risk factor for an adverse event within 90 days (adjusted odds ratio, 7.2; 95% CI, 3.9–13.3).
Conclusion. Lack of appropriate antidiabetic treatment after discharge from an emergency SSU is a risk factor for adverse events within 90 days.

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