Low Glucose Levels at Hospital Discharge Tied to Poor Outcomes
WEDNESDAY, May 8, 2019 -- Patients with diabetes who have hypoglycemia or near-normal glucose values during the last day of hospitalization have higher rates of 30-day readmission and postdischarge mortality, according to a study published online May 1 in the Journal of Clinical Endocrinology & Metabolism.
Elias Spanakis, M.D., from the Baltimore VA Medical Center, and colleagues used data from 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals during a 14-year period to investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk for readmission or mortality.
The researchers found that the rate ratios (RR) increased progressively for all five outcomes of interest (30-day readmission rate; 30-day, 90-day, and 180-day mortality rate; and combined 30-day readmission/mortality rate) as the minimum glucose concentrations progressively decreased below 90 to 99 mg/dL versus 100 to 109 mg/dL (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; and 180-day mortality RR, 1.03 to 1.91). The 30-day readmission rate; 30-, 90-, and 180-day postdischarge mortality rate; and combined 30-day readmission/mortality rate were all greater for patients with diabetes 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.
"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 mellitus medications or [advising] patients to perform frequent glucose monitoring or use continuous glucose monitoring devices," the authors write.
Several authors disclosed financial ties to the medical device and pharmaceutical industries.
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Posted: May 2019