Learning Objective: This study evaluates the frequency of newly initiated insulin at hospital discharge in insulin-naive adults with type 2 diabetes and hemoglobin A1c (HbA1c) 6.5–10%, assesses potential eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, and examines associated clinical outcomes, including 30-day all-cause readmissions, emergency department visits, and urgent care visits.
Self-Assessment Question: When are GLP-1 receptor agonists (GLP-1RAs) appropriate for hospitalized insulin-naive adults with type 2 diabetes and hemoglobin A1c 6.5–10% who are discharged on insulin, and how might this choice affect 30-day readmission rates?
Background/Objective: Guidelines favor GLP-1RAs over insulin in type 2 diabetes and a HbA1c under 10%. Studies show these patients are often discharged on insulin, although GLP-1RAs give similar glycemic control and cardiovascular, renal, and weight loss benefits.
Methods: This retrospective chart review included adults 18 years or older with type 2 diabetes discharged home from WellSpan hospitals, HbA1c 6.5–10%, and no insulin prior to admission. Exclusion criteria included type 1 diabetes, gestational diabetes, latent autoimmune diabetes in adults, pregnancy, insulin or GLP-1RA on home medication list, and insulin orders from the (diabetic ketoacidosis/hyperosmolar hyperglycemic state) DKA/HHS order-set. The primary outcome was potential GLP-1RA therapy eligibility. Secondary outcomes included frequency of insulin-naive patients discharged on an insulin regimen and 30-day all-cause readmissions and emergency department or urgent care visits.
Results: Among 193 patients, 91.2% met criteria for potential GLP-1RA therapy eligibility. Regarding discharge practices, 12 patients were discharged on an insulin regimen while 181 were not. Among those discharged on insulin, 4 patients (33.3%) experienced a 30-day all-cause readmission. In comparison, 37 patients (20.4%) not discharged on insulin were readmitted within 30 days. Emergency department or urgent care visit rates followed a similar trend, with higher utilization observed in the insulin-discharge group. Overall, a large proportion of patients were eligible for GLP-1RA therapy, while discharge on insulin was less frequent but associated with higher short-term healthcare utilization.
Conclusions: Most patients were eligible for GLP-1RA therapy, and few were discharged on insulin. Differences in 30-day readmissions and acute care utilization were observed between groups, though interpretation is limited by small sample size. These findings highlight an opportunity to optimize discharge processes within transitions of care and support guideline-concordant outpatient diabetes management, including greater consideration of GLP-1RA therapy when clinically appropriate.
