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Hospital Readmissions for Diabetes and the Impact of Hypo- and Hyperglycemic Events
TAKE-HOME MESSAGE
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The authors sought to address the problem of hospital readmission and post-discharge care for adults ≥18 years of age with diabetes (index hospitalizations, N = 594,146). Mean age was 68 years, 53% were female, and 68% were white. Index hospitalizations included heart failure (5.5%, with 8.9% readmissions) and severe dysglycemia (2.6%, with 2.5% readmissions). Younger age and severity of dysglycemia at index hospitalization were risk factors most likely to affect readmissions. The Diabetes Complications Severity Index (DCSI) was also relevant in other-cause readmissions.
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Hospital readmission rates are high among adults with diabetes, with severe glycemia the strongest risk factor for younger patients with additional complications and prior history.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management.
OBJECTIVE
To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia.
DESIGN
Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S.
PARTICIPANTS
Adults ≥18 years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N = 342,186).
MAIN MEASURES
Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes.
KEY RESULTS
We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2 years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization.
CONCLUSIONS
Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.
Additional Info
Disclosure statements are available on the authors' profiles:
Hospital Readmissions Among Commercially Insured and Medicare Advantage Beneficiaries With Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events
J Gen Intern Med 2017 Jul 06;[EPub Ahead of Print], RG McCoy, KJ Lipska, J Herrin, MM Jeffery, HM Krumholz, ND ShahFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This paper describes the most common reasons and risk factors for unplanned hospital readmissions within 30 days of discharge among adults with diabetes in the US. Data were obtained from a very large, nationally representative administrative database of patients with commercial insurance or Medicare Advantage plans. The authors are to be applauded for their rigorous analysis. Their finding that heart failure was the most common reason for admission and readmission is consistent with what is reported in prior literature. The reported all-cause readmission rate of 10.8%, however, is lower than that reported in most other studies of diabetes patients (13%–20%). This discrepancy is likely a result of many high-risk patients or hospitalizations being excluded, including: 1) patients without insurance and those with public health coverage; 2) hospitalizations with another discharge within 30 days before the index admission; 3) length of stay >365 days; and 4) a principal diagnosis of a psychiatric condition or cancer.
The authors found that 2.6% of index hospitalizations and 2.5% of readmissions were attributed to severe dysglycemia (hyper- or hypoglycemia), which is almost certainly an underestimate of actual severe dysglycemia because cases were defined only by primary diagnostic codes, not laboratory values.
The authors correctly conclude that younger patients with more diabetes complications are at higher risk of admission and readmission for severe dysglycemia and may benefit from diabetes-specific interventions. Such interventions could include inpatient education, care coordination with a discharge transition nurse, medical management by a diabetes team, and rapid outpatient follow-up, although these interventions have not been well tested in randomized controlled trials. A risk prediction tool such as the Diabetes Early Readmission Risk Indicator (DERRI) may also be useful to focus resources on higher-risk patients.