For patients with diabetes who are hospitalized, hypoglycemia or near-normal glucose values during the last 24 hours of hospitalization can lead to higher rates of 30-day readmission and mortality, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

The study included data from hospital admissions of participants with diabetes at Veteran Affairs hospitals over a 14-year period (n = 843,978). During the last 24 hours of hospitalization, minimum point-of-care glucose values were collected. The researchers examined adjusted rates of 30-day readmission; 30-day, 90-day, and 180-day mortality; and combined 30-day readmission/mortality to identify minimum glucose thresholds above which participants can be safely discharged.

Of the study participants, 18.8% died or were readmitted within 30 days of their initial discharge. The mean age of participants at admission was 66.8 ± 10.8 years. A total of 15.2% of participants were discharged with minimum glucose values of 100 to 109 mg/dL.

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Compared with minimum glucose values between 100 and 109 mg/dL, rate ratios increased as the minimum glucose concentrations decreased below the 90 to 99 mg/dL category. Rate ratios ranged from 1.01 to 1.45 for 30-day readmission, 1.01 to 1.71 for 30-day readmission/mortality, 0.99 to 5.82 for 30-day mortality, 1.01 to 2.40 for 90-day mortality, and 1.03 to 1.91 for 180-day mortality.

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The researchers calculated that participants with diabetes and glucose levels <92.9 mg/dL experienced greater 30-day readmission rates. For 30-, 90- and 180-day postdischarge mortality, patients experienced progressive increases when blood glucose was <45.2 mg/dL, <65.8 mg/dL, and <67.3 mg/dL, respectively. A notably higher rate for combined 30-day readmission/mortality was associated with glucose levels <87.2 mg/dL.

“Potential approaches which may reduce the risk for readmission or death after discharge are: Delaying patient release from the hospital until normoglycemia is achieved, modifying outpatient [diabetes] medications or [advising] patients to perform frequent glucose monitoring or use continuous glucose monitoring devices,” the researchers wrote.

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Spanakis EK, Umpierrez GE, Siddiqui T, et al. Association of glucose concentrations at hospital discharge with readmissions and mortality: a nationwide cohort study [published online May 1, 2019]. J Clin Endcrinol Metab. doi:10.1210/jc.2018-02575