- In hospitalized patients with diabetes, hypoglycemia or low-normal glucose values on the last inpatient day carry greater risk for 30-day readmission and postdischarge mortality.
- Potential mitigation strategies: delaying discharge until normoglycemia is achieved, modifying outpatient diabetes medications, advising patients to perform frequent glucose monitoring.
Why this matters
- Reducing hospital readmissions is a high priority for quality health care.
- Nationwide study; 843,978 patients with diabetes admitted to Veteran Affairs hospitals over 14 years.
- Outcomes: adjusted 30-day readmission rates; 30-, 90-, and 180-day mortality; and combined 30-day readmission/mortality.
- Funding: US Department of Veterans Affairs; Baltimore Veterans Affairs.
- Hypoglycemia (
- Vs glucose 100-109 mg/dL on final inpatient day, patients with hypoglycemia had significantly higher rates (rate ratios; 95% CIs) of dying within:
- 30 days: 1.39 (1.32-1.47);
- 90 days: 1.30 (1.26-1.34); and
- 180 days: 1.27 (1.24-1.30).
- Rate ratios for severe hypoglycemia:
- 30 days: 2.24 (1.96-2.57);
- 90 days: 1.81 (1.66-1.97); and
- 180 days: 1.66 (1.55-1.77).
- Rate ratios for 30-day readmission or 30-day readmission/death:
- 1.20 (1.18-1.23) and 1.22 (1.20-1.24) with hypoglycemia;
- 1.32 (1.24-1.40) and 1.39 (1.32-1.46) with severe hypoglycemia.
- Single health care system.
- All-veteran population.
- Administrative data.