MON-660 - Real World Utilization of Therapies for Diabetes and Cardiorenal Metabolic Health in Eligible Hospitalized Patients

Study

Objective: Describe the current state of patients with diabetes (DM) who were hospitalized and required new start insulin upon discharge and received therapies for cardiorenal metabolic health (CRM) within 90 days of hospital discharge.

Methods: Retrospective chart review of English-speaking patients, 21 - 80 years, with a new insulin prescription at hospital discharge who were enrolled in a single site randomized controlled trial to evaluate a DM Discharge Toolkit. Our goal was to evaluate baseline technology acceptance and CRM medication use.

Results: Of 88 participants enrolled, the mean age was 53 (SD 14); average body mass index was 33 (SD 9); 65% were male; 41% had public insurance; 46% identified as black, 32% white, and 25% Hispanic/Latino; 66% had prior DM, and 26% had cardiovascular disease and 14% had renal disease at baseline. Acceptance of research continuous glucose meter (CGM) at discharge was high (51%) and CGM use increased over time. Baseline stress was high (62% with Perceived Stress Scale >14 and 40% of those with prior DM had a DM Distress Score > 2.0). Food insecurity was also high (19%). Prior to admission, 28% of participants were on an SGLT2 inhibitor (SGLT2i) and 27% were on a GLP-1 receptor agonist (RA). Upon hospital discharge, of all enrolled patients discharged on insulin, 30% were on an SGLT2i and 35% were on a GLP-1 RA. At 30 days, those on SGLT2is dropped down to 18%, those on a GLP-1 RA increased to 43%, and 16% were no longer on insulin. By 90-day post-discharge, SGLT2i frequency remained at 20% but GLP-1 RA use increased to 54% and 24% of patients were no longer on insulin.

Conclusion: The American Diabetes Association Standards of Care recognizes an expanded role of SGLT2is and GLP-1 RAs for cardiovascular and renal risk reduction. However, real-world prescribing patterns of these agents among high risk-patients remain poorly characterized. In our cohort, SGLT2i use remained largely stable from discharge through 90-day follow-up, whereas GLP-1 RA adoption increased substantially, accompanied by a reduction in insulin use. Technology use in this population was readily accepted to enhance their DM care delivery. These findings shed light on opportunities to optimize the care of patients with diabetes newly started on insulin in the hospital with diabetes technology and therapeutics to maximize cardiorenal metabolic risk reduction.

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