Table 1: Suggested use of the HA1c during hospitalization for discharge planning for hyperglycemic patients.

Unknown diabetes Known diabetes Followup HA1c < 6.5%* Assess diabetes risk factors. Counseling and outpatient screening within 3 months     HA1c 6.5–7%* and insulin requirement < 0.4 units/kg/day Counseling and outpatient screening within 3 months ± pharmacologic prevention** Assess for hypoglycemia risk. Continue prehospital regime unless new safety concerns. Communicate recommendation to outpatient providers. Address need for referral to multidisciplinary care for diabetes treatment or prevention HA1c 6.5–7%* and insulin requirement ≥ 0.4 units/kg/day Counseling and initiation of appropriate diabetes treatment plan   HA1c > 7%* Counseling and initiation of appropriate diabetes treatment plan Consider transient effect of subacute illness (e.g., angina) prior to hospitalization on HA1c. Consider advising augmentation of outpatient regimen to target <7%

Adapted from Supplement to ACP Hospitalist. December 15, 2009. *Note, the A1c is inaccurate after blood transfusion and in severe anemia, or in high or low red blood cell turnover states. **Metformin or acarbose.