Framework for an Individualized Approach to the Pre-Discharge Evaluation of Older, Hospitalized Patients With Diabetes

1. Evaluate for geriatric syndrome:
 • Depression
 • Urinary incontinence
 • Fall risk
 • Vision/hearing problems
2. Avoid polypharmacy.
3. Set outpatient A1C target.
4. Avoid complexity of antihyperglycemic regimen.
5. Reassess regarding whether metformin can be continued or initiated.
6. Reduce the risk of hypoglycemia:
 • Limit use of sulfonylurea medications.
 • Use physiologic insulin regimens.
 • Prefer use of only basal insulin in the early phases of hyperglycemia correction.
 • Consider a DPP-4 inhibitor instead of initiation or escalation of insulin in patients with an A1C <9.0%.
7. Provide close follow-up in outpatient setting.