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J Clin Endocrinol Metab. 2019 Sep 1;104(9):3679-3691. doi: 10.1210/jc.2018-02575.

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

Author information

1
Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland.
2
Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland.
3
Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia.
4
Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland.
5
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland.
6
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
7
Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Baltimore, Maryland.

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.

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