Hypoglycemic timeslots after hospital discharge in patients with diabetes on multiple daily insulin injection: Dose of Insulin CHanged According to the Reported Glucose by Libre Pro (DISCHARGe study)

Insulin improves clinical outcomes in hospitalized patients; however, hypoglycemia hinders discharge transition in patients with insulin-treated diabetes. Studies on hypoglycemic timeslots, rates, and risk factors during discharge transition are lacking. Fifteen patients with type 2 diabetes (T2D) receiving multiple daily insulin (MDI) injections participated. Glucose variability metrics and hypoglycemia were monitored using a continuous glucose monitoring system starting a day pre-discharge through 13 days of discharge transition. Hypoglycemia was analyzed chronobiologically using Cosinor analysis. Anthropometric measurements, C-peptide, insulin dose, and glucagon were assessed. The mean patient age was 52.7 ± 12.6 years; 13/15 were male; body mass index was 28.1 ± 5.9 kg/m2, T2D duration was 8.6 ± 8.8 years, HbA1c was 12.4 ± 2.5%, and total daily insulin dose averaged 36.6 ± 15.1 units and hospitalization lasted 13.1 ± 2.3 days. Time in range decreased post-discharge. Time below range increased from 7.0% at discharge to 17.6% by the study end (manova, P < 0.001). Hypoglycemic events peaked post-breakfast, with the highest amplitude (42 points) recorded at 12:00. The highest and lowest numbers of hypoglycemia occurred at 12:00 and 17:30, respectively. However, the highest hypoglycemic timeslot (11:00-12:00) was not significantly associated with clinical and biochemical parameters. The chronobiology of hypoglycemia exists during the discharge transition in patients with MDI-treated T2D. Hypoglycemia frequency and severity peaked pre-lunch, reached a nadir at 17:30, and exaggerated post-discharge, emphasizing the need for pre-breakfast insulin dose reductions on the discharge day.