ArticleJournal of general internal medicine2019
The Association Between Insulin Initiation and Adverse Outcomes After Hospital Discharge in Older Adults: a Population-Based Cohort Study.
Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Predictors of 30-day unplanned hospital readmission among adult patients with diabetes mellitus: a systematic review with meta-analysis.BMJ open diabetes research & care · 2020Pooled it
- Medication Errors and Gaps in Medication Discharge Planning for Hospitalized Older Adults: A Prospective Cohort Study.Journal of general internal medicine · 2026Article
- Leveraging User-Centered Design and Usability and Skills Testing for a Novel Diabetes Survival Skills Toolkit.Journal of the Endocrine Society · 2025Article
- A Multi-Outcome Prognostic Model for Community-Dwelling Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care.Journal of the American Medical Directors Association · 2025Article
- Inpatient Metformin Utilization and Post-hospitalization Clinical Outcomes: An Observational Cohort Study.Journal of general internal medicine · 2025Article
- Developing a Diabetes Discharge Order Set for Patients With Diabetes on Insulin.Journal of diabetes science and technology · 2024Article
- Article
- Intensification of Diabetes Medications at Hospital Discharge and Clinical Outcomes in Older Adults in the Veterans Administration Health System.JAMA network open · 2021Article
- Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.International journal of environmental research and public health · 2021Article
- Patterns and predictors of antihyperglycemic intensification at hospital discharge for type 2 diabetic patients not on home insulin.Journal of clinical & translational endocrinology · 2020Article
- Prevalence of Diabetes Medication Intensifications in Older Adults Discharged From US Veterans Health Administration Hospitals.JAMA network open · 2020Article
- Discharge pharmacotherapy for Type 2 diabetic inpatients at two hospitals of different tiers in Zhejiang Province, China.PloS one · 2020Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundStarting insulin therapy in hospitalized patients may be associated with an increase in serious adverse events after discharge.
objectiveDetermine whether post-discharge risks of death and rehospitalization are higher for older hospitalized patients prescribed new insulin therapy compared with oral hypoglycemic agents (OHAs).
designRetrospective population-based cohort study including hospital admissions in Ontario, Canada, between April 1, 2004, and Nov 30, 2013. PATIENTS: Persons aged 66 and over discharged after a hospitalization and dispensed a prescription for insulin and/or an OHA within 7 days of discharge. We included 104,525 individuals, subcategorized into four mutually exclusive exposure groups based on anti-hyperglycemic drug use in the 7 days post-discharge and the 365 days prior to the index admission. MAIN MEASURES: Prescriptions at discharge were categorized as new insulin (no insulin before admission), prevalent insulin (prescribed insulin before admission), new OHA(s) (no OHA or insulin before admission), and prevalent OHA (prescribed OHA only before admission) as the referent category. The primary and secondary outcomes were 30-day deaths and emergency department (ED) visits or readmissions respectively. KEY
resultsOf 104,525 patients, 9.2% were initiated on insulin, 4.1% died, and 26.2% had an ED visit or readmission within 30 days of discharge. Deaths occurred in 7.14% of new insulin users, 4.86% of prevalent insulin users, 3.25% of new OHA users, and 3.45% of prevalent OHA users. After adjustment for covariates, new insulin users had a significantly higher risk of death (adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.46 to 1.74) and ED visit/readmissions (aHR 1.17, 95% CI 1.12 to 1.22) than prevalent OHA users.
conclusionsInitiation of insulin therapy in older hospitalized patients is associated with a higher risk of death and ED visits/readmissions after discharge, highlighting a need for better transitional care of insulin-treated patients.
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