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.
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.
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.
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