Effect of Inpatient Diabetes Management on Outpatient Glycemic Control

Inclusion Criteria:

• Age > 18 years
• Known diagnosis of type 2 diabetes by history with outpatient prescription of oral hypoglycemic medication or insulin
• Hemoglobin A1c > 8.0% within the prior 12 months, or if not known, fasting blood glucose greater than 200 mg/dl on sliding scale regular insulin.
• Partners-affiliated primary care physician

Exclusion Criteria:

• Screening HbA1c returns less than 8%.
• Diabetic ketoacidosis (DKA) as a primary reason for admission (admission blood glucose > 250 mg/dl with arterial pH < 7.30 or serum bicarbonate level < 15 mg/dl), or development of DKA during admission.
• Hyperosmolar hyperglycemic syndrome as a primary reason for admission (admission blood glucose > 400 mg/dl and plasma osmolality > 315 mOsm/kg.
• Pregnancy, ruled out by urine HCG test at screening after consent is obtained in all women who continue to have menstrual cycles.
• Anemia with hemoglobin < 9 g/dl, recent blood transfusion, or need for blood transfusion (interferes with interpretation of hemoglobin A1c assay)
• End stage liver disease with prothrombin time > 15 seconds and albumin <3 mg/dl
• End stage renal disease: Stage IV (glomerular filtration rate <30 mg/dl) or V chronic kidney disease
• Treatment with corticosteroids
• ICU transfer
• Inability to self-administer insulin
• Hypoglycemia unawareness: patient lacks sensation of common signs of blood glucose < 60 mg/dl (tachycardia, diaphoresis, hunger, confusion, fatigue).
• Projected survival < 1 year