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

Unknown diabetesKnown diabetesFollowup

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/dayCounseling 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/dayCounseling 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.