From the Guidelines
The correct approach at admission is to check HbA1c since the last test was >3 months prior to admission. According to the most recent and highest quality study 1, the recommendation is to perform an A1C test on all people with diabetes or hyperglycemia admitted to the hospital if no A1C test result is available from the prior 3 months. This approach is supported by the fact that the patient's last HbA1c was checked 4 months prior to admission, which is beyond the recommended 3-month interval. The patient's current hospitalization for community-acquired pneumonia does not preclude the need for assessing glycemic control, as the HbA1c measurement can provide valuable information on the patient's preadmission glycemic status. Key points to consider in the management of this patient's diabetes include:
- Assessing the patient's diabetes self-management knowledge and behaviors on admission
- Providing diabetes self-management education, if appropriate
- Using validated written or computerized protocols for insulin administration and glucose monitoring
- Considering the use of structured order sets and computerized provider order entry (CPOE) to improve glycemic management and reduce medication-related errors. Overall, checking the HbA1c at admission will help guide the management of the patient's diabetes during the hospital stay and ensure that clinical decisions are based on reliable data.
From the Research
Admission Protocol for a Patient with Type 2 Diabetes
At admission, the following steps should be considered for a patient with type 2 diabetes:
- Check HbA1c since the last test was >3 months prior to admission, as this will provide an updated assessment of the patient's glycemic control 2, 3.
- This is particularly important in the context of an acute illness, such as community-acquired pneumonia, as it may impact the patient's blood glucose levels and overall management plan.
- The patient's current HbA1c level will help guide treatment decisions and ensure that their diabetes management plan is optimized during their hospital stay.
Rationale for Checking HbA1c
The rationale for checking HbA1c at admission is based on the following:
- HbA1c levels provide a measure of average blood glucose control over the past 2-3 months, which is essential for guiding treatment decisions 4, 5.
- Studies have shown that metformin, which the patient is currently taking, can effectively lower HbA1c levels by 1-2 percentage points when used as monotherapy or in combination with other agents 5, 3.
- Checking HbA1c at admission will help determine if the patient's current treatment plan is effective and if any adjustments are needed to achieve optimal glycemic control.
Considerations for Patients with Type 2 Diabetes
When managing patients with type 2 diabetes, the following considerations should be kept in mind:
- The patient's blood glucose levels and HbA1c should be monitored regularly to ensure that their treatment plan is effective and to make any necessary adjustments 2, 3.
- The use of metformin and other glucose-lowering agents should be guided by the patient's individual needs and medical history, as well as the potential risks and benefits of each medication 6, 5.