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Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality
TAKE-HOME MESSAGE
- In this large cohort study (N = 843,978), the authors evaluated the association between discharge day low blood glucose concentrations and 30-day readmission and post-discharge mortality rates. They determined that, as discharge day glucose concentrations decreased, 30-day readmission rates increased. Also, 30-day, 90-day, and 180-day mortality rates increased as discharge day glucose concentrations deceased.
- In patients with underlying diabetes, hypoglycemia or low-normal glucose values on discharge day were associated with a higher risk for mortality after discharge and a higher rate of 30-day readmission.
abstract
This abstract is available on the publisher's site.
Access this abstract nowCONTEXT
Low blood glucose concentrations during the discharge day may affect 30-day readmission and post hospital discharge mortality rates.
OBJECTIVE
To investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk of readmission or mortality.
DESIGN
Minimum point of care glucose values were collected during the last 24 hours of the hospitalization. We used adjusted rates of 30-day readmission rate, 30-day, 90-day, and 180-day mortality rate and combined 30-day readmission/mortality rate to identify minimum glucose thresholds above which patients can be safely discharged.
SETTING
Nation-wide cohort study including 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals over a 14-year period.
MAIN OUTCOMES
30-day readmission rate, 30-day, 90-day, and 180-day mortality rate and combined 30-day readmission/mortality rate.
RESULTS
The rate ratios (RR) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90-99 mg/dl category, compared to the 100-109 mg/dl category: 30-day readmission RR 1.01 to 1.45, 30-day readmission/mortality RR 1.01 to 1.71, 30-day mortality RR 0.99 to 5.82, 90-day mortality RR 1.01 to 2.40, 180-day mortality 1.03 to 1.91. Patients with diabetes experienced greater 30-day readmission rate, 30-, 90- and 180-day post-discharge mortality and higher combined 30-day readmission/mortality with glucose levels <92.9 mg/dl, <45.2 mg/dl, 65.8 mg/dl and 67.3 mg/dl and <87.2 mg/dl, respectively.
CONCLUSIONS
Patients with diabetes who had hypoglycemia or near normal glucose values during the last day of hospitalization had higher rates of 30-day readmission and post discharge mortality.
Additional Info
Disclosure statements are available on the authors' profiles:
Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study.
J. Clin. Endocrinol. Metab. 2019 May 01;[EPub Ahead of Print], EK Spanakis, GE Umpierrez, T Siddiqui, M Zhan, S Snitker, JC Fink, JD SorkinFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In this nationwide, retrospective cohort study of 843,978 admissions at Veteran Affairs (VA) hospitals of patients with diabetes, the risk of 30-day readmission or mortality within 30, 90, or 180 days after discharge increased progressively as minimum blood glucose (BG) concentrations decreased below 90 mg/dL during the final 24 hours of hospitalization. Although hypoglycemia has been associated with mortality in both inpatient and outpatient settings,1,2 this is the first study to examine pre-discharge hypoglycemia and post-discharge adverse events. Because BG levels are modifiable, this study raises the possibility that avoidance of hypoglycemia during the 24 hours before discharge may decrease the risk of readmission or post-discharge mortality. This study does not, however, answer the question of whether patients with hypoglycemia would benefit from delaying discharge until BG levels normalize. Randomized controlled trials are needed to determine optimal strategies for transitioning patients with diabetes out of hospitals, as the authors acknowledge. Despite some limitations on generalizability (study period 2000–2014, VA population at VA hospitals, no ICU admissions), this paper draws attention to an important area of study relevant to the more than 8 million discharges of patients with diabetes from US hospitals annually.3
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