Low in-hospital glucose is linked to more readmissions, postdischarge deaths

  • Spanakis EK & al.
  • J Clin Endocrinol Metab
  • 1 May 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Single health care system.
  • All-veteran population.  
  • Administrative data.