(297) Antidiabetic Agent (ADA) Prescribing Patterns Post-Hospital Discharge for Critically Ill Adults

Introduction: ICU hyperglycemia is associated with new therapies and diagnosis (Dx) of diabetes mellitus (DM). Post-hospital (hosp) prescription (Rx) of antidiabetic agents (ADA) is not well described after an ICU admission with mechanical ventilation (MV) in patients not previously prescribed an ADA [i.e., ADA-naïve (N)]. Moreover, post-hosp ADA prescribing may be inconsistent between ADA-N, ADA-experienced (ADA-E), and patients diagnosed with DM.

Methods: A retrospective assessment of the U.S. IQVIA PharMetrics Plus claims database identified adults admitted to an ICU requiring MV and discharged directly to home with insurance coverage ≥30 days in 2021. Patients excluded for recent ICU admission or DKA or HHS. Data collected: age, sex, comorbidity (CCI), frailty (HFRS), admission Dx ICD-10, DM diagnosis, Rx for 10 different ADA classes in the 2 months before and after the ICU Hosp (including biguanides, DPP-4 inhibitors, GLP-1 agonists, insulin, SGLT-2 inhibitors and sulfonylureas). 6-variable logistic regression analysis done to identify factors associated with post-hosp ADA prescribing in the ADA-N cohort. No data was collected for hospital clinical status or medications.

Results: Among the 2741 study patients, 2356(86.0%) were ADA-N [male 54.7%, age median(IQR) 67(56-76) yr, CCI 5(3,8), HFRS 11(6,18), prior DM 14.4%, medical 85.7%] and 385(14.0%) were ADA-E. A total of N=101(4.2%) of the ADA-N group were prescribed ≥1 new ADA in the 2 months post-ICU hosp; 90% Rx =1 agent (biguanides 44.0%, insulin 35.2%). In the ADA-N group, prior DM Dx (aOR 4.98 95% CI 2.97,8.29) was associated with greater post-hosp ADA Rx but higher age (aOR 0.98 95%CI 0.97-1.0) and greater frailty (aOR 0.96 95% 0.94,0.99) with less. Among the ADA-E patients, only 215(55.6%) were prescribed an ADA post-hosp, despite a similar DM diagnosis frequency before (73.8%) and after (75.3%) hosp.

Conclusions: New ADA prescribing is infrequent for adults in ICU with MV within 2 months post-hospital when ADA-N patients are discharged home, particularly in patients who are older and more frail. It remains unclear why post-hospital ADA prescribing was lower in the ADA-E group when the DM diagnosis frequency did not change after discharge. The clinical impact of hospital-based alterations in ADA use requires further research.