medwireNews: Hospitalized individuals with diabetes who have low blood glucose levels on the day of discharge have an elevated risk for readmission and death, findings from a large US cohort study suggest.
Elias Spanakis, from the University of Maryland School of Medicine in Baltimore, USA, and colleagues analyzed data from 843,978 hospital stays in the Veterans Affairs health system between 2000 and 2014. People were readmitted to hospital within 30 days of discharge in 17.3% of cases, and the rates of mortality at 30, 90, and 180 days after discharge were 2.3%, 6.0%, and 10.0%, respectively.
During the last 24 hours of hospital stay, patients’ glucose levels fell into deciles ranging from 10–19 to 170–179 mg/dL, with the majority (15.2%) of individuals having levels between 100 and 109 mg/dL.
The researchers report that as glucose levels progressively decreased below 100 mg/dL, the proportion of people experiencing the outcomes of 30-day readmission, 30-, 90-, and 180-day mortality, or the combined outcome of 30-day readmission or mortality gradually increased.
For instance, the adjusted rate of readmission within 30 days was 13.7% for the 128,530 occurrences of hospital discharge in which the patient had glucose levels between 100 and 109 mg/dL, rising to 14.9% for the 56,997 discharges in the 70–79 mg/dL category, 18.0% for the 11,032 in the 40–49 mg/dL category, and 19.9% for the 134 in the 10–19 mg/dL category.
Compared with individuals in the 100–109 mg/dL category, those in the 70–79 mg/dL category had a significant 9% higher risk for readmission within 30 days after accounting for factors including age, BMI, sex, and comorbidities, while those in the 40–49 and 10–19 mg/dL groups had a significant 32% and 46% increased risk, respectively.
Spanakis and team say that the reasons behind the increased readmission risk among individuals with glucose levels in the “low-normal” category of 70–93 mg/dL are not known, but they hypothesize that those “with glucose levels close to the hypoglycemia range prior to discharge are more likely to develop even lower glucose values after discharge.”
They report similar significant associations between low glucose levels and mortality risk, but glucose levels above 109 mg/dL were not linked to a significantly increased risk for any of the adverse outcomes in the majority of hyperglycemia categories.
The investigators used a piecewise linear continuous regression approach to identify threshold glucose levels below which individuals had an increased risk for adverse outcomes, and defined cutoffs of 92.9 mg/dL for 30-day readmission, 45.2, 65.8, and 67.3 mg/dL for 30-, 90-, and 180-day mortality, respectively, and 87.2 mg/dL for the combined outcome of 30-day readmission or mortality.
Spanakis et al conclude in The Journal of Clinical Endocrinology & Metabolism that potential strategies to reduce hospital readmission and mortality risk include “[d]elaying 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 (CGM) devices.”
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J Clin Endocrinol Metab 2019; doi:10.1210/jc.2018-02575
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