End of hospital stay glucose variability indicates readmission likelihood
medwireNews: People with diabetes who have high glucose variability on the last day of a hospital stay are at increased risk for being readmitted within 30 days, shows a US nationwide study.
“Recently, we have reported an association of lower glucose values on the last inpatient day with increased rate of 30-day readmission,” say Elias Spanakis (Baltimore Veterans Affairs Medical Center, Maryland) and co-researchers.
This together with the latest findings “may shed light on two potentially modifiable risk factors for reducing 30-day readmissions,” they say, adding that prospective trials are needed to determine whether addressing these factors can reduce readmission risk.
The team identified 1,042,150 people with diabetes admitted to hospital within the US Veterans Affairs health system and divided them into deciles according to their glucose coefficient of variation (CV) on their final day in hospital. The study cohort was 97.2% male and 71.6% Caucasian, with an average age of 66.5 years and median length of stay of 3.9 days. Hypoglycemia occurred during the last 24 hours of the hospital stay in 7.35% of patients.
The glucose CV ranged from 3.6 in the first decile to 56.2 in the 10th. People from the fifth decile upwards had a significantly increased risk for readmission within 30 days relative to those in the first, ranging from a 2% increase for those in the fifth decile to an 8% increase for those in the 10th.
This association was independent of factors including age, sex, race, length of stay, medications, income, BMI, comorbidities, and hypoglycemia during the final 24 hours in hospital. Hypoglycemia in the last 24 hours of hospitalization was markedly more common among patients in the highest three deciles of glucose variability than those in the lower deciles, at 19.4% versus 1.3–3.5%.
The results were similar when the team used glucose standard deviation rather than CV, with the risk increase for readmission starting at 4% for people in the fourth decile and rising to 11% for those in the 10th in the adjusted analysis.
“The transition of care from inpatient to the outpatient setting signifies a vulnerable and challenging time with greater risk of dysglycemia, as well as healthcare utilization such as emergency room visits or readmissions,” write Spanakis and team in BMJ Open Diabetes Research & Care.
They believe a possible explanation for the association “is that high [glucose variability] predisposes patients to postdischarge hypoglycemia or to significant hyperglycemia, which may lead to readmission.”
But the team cautions that “it remains debatable whether [glucose variability] should be considered a treatment target,” given the uncertainty creating by the variety of indices and definitions currently in use.
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