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    Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study

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    Author
    Spanakis, E.K.
    Umpierrez, G.E.
    Siddiqui, T.
    Zhan, M.
    Snitker, S.
    Fink, J.C.
    Sorkin, J.D.
    Date
    2019
    Journal
    The Journal of clinical endocrinology and metabolism
    Publisher
    Oxford Academic
    Type
    Article
    
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    Show full item record
    See at
    https://www.doi.org/10.1210/jc.2018-02575
    Abstract
    CONTEXT: Low blood glucose concentrations during the discharge day may affect 30-day readmission and posthospital 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 AND OUTCOMES: Minimum point of care glucose values were collected during the last 24 hours of hospitalization. We used adjusted rates of 30-day readmission rate, 30-, 90-, and 180-day mortality rates, and combined 30-day readmission/mortality rate to identify minimum glucose thresholds above which patients can be safely discharged. PATIENTS AND SETTING: Nationwide cohort study including 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals 14 years. RESULTS: The rate ratios (RRs) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90 to 99 mg/dL category, compared with the 100 to 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 RR, 1.03 to 1.91. Patients with diabetes experienced greater 30-day readmission rates, 30-, 90- and 180-day postdischarge mortality rates, and higher combined 30-day readmission/mortality rates, with glucose levels <92.9 mg/dL, <45.2 mg/dL, 65.8 mg/dL, 67.3 mg/dL, and <87.2 mg/dL, respectively. CONCLUSION: 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 postdischarge mortality.
    Keyword
    Blood Glucose
    Diabetes Mellitus
    Patient Discharge
    Patient Readmission
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070180384&doi=10.1210%2fjc.2018-02575&partnerID=40&md5=203cf7a7b9680e0e117e326d04250127; http://hdl.handle.net/10713/10361
    ae974a485f413a2113503eed53cd6c53
    10.1210/jc.2018-02575
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