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J Diabetes Complications. 2018 Jul;32(7):693-701. doi: 10.1016/j.jdiacomp.2018.04.007. Epub 2018 Apr 24.

Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes.

Author information

1
Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: mccoy.rozalina@mayo.edu.
2
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, PO Box 208056, New Haven, CT 06520, United States.
3
Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, PO Box 208020, New Haven, CT 06520, United States.
4
Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; OptumLabs, 1 Main Street, 10th Floor, Cambridge, MA 02142, United States.

Abstract

AIMS:

Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes.

METHODS:

Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia.

RESULTS:

After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5-0.9 for 45-64 vs. <45 years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2-0.7). New hypoglycemia readmissions were most likely among patients ≥75 years (OR 13.3, 95% CI 2.4-73.4, vs. <45 years).

CONCLUSIONS:

Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events.

KEYWORDS:

Diabetes; Hospitalization; Hyperglycemic hyperosmolar state (HHS); Hypoglycemia; Ketoacidosis (DKA); Readmission

PMID:
29751961
PMCID:
PMC6015781
DOI:
10.1016/j.jdiacomp.2018.04.007
[Indexed for MEDLINE]
Free PMC Article

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