Heart failure, dysglycemia put patients with diabetes at high risk for hospitalization, rehospitalization

By Liz Meszaros, MDLinx
Published July 12, 2017

Key Takeaways

Patients with diabetes are at risk for hospitalization due to many health conditions, with heart failure being the most common cause, followed by severe hypoglycemia and hyperglycemia. In addition, patients with severe dysglycemia are at an even higher risk for rehospitalization, according to a new study published in the Journal of General Internal Medicine.

“We already knew that adults with diabetes carry a high risk for hospitalization and unplanned readmission,” said lead author Rozalina McCoy, MD, internal medicine physician and endocrinologist, Mayo Clinic, Rochester, MN. “But the big question was why? And what role did episodes of very high and very low blood sugar play in this risk? Because if we knew what the problem was, and ultimately why it might be happening, we could then try to prevent it.”

Researchers conducted this retrospective study to determine the most common reasons and risk factors for readmission to the hospital in adults with diabetes, and in particular, severe dysglycemia.

Using data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the US, they identified 342,186 adults greater than 18 years old with diabetes who had been discharged from a hospital between January 1, 2009 and December 31, 2014. They analyzed data for principal diagnoses and risk factors for 30-day unplanned readmissions.

In all, 594,146 index hospitalizations in adults with diabetes (mean age: 68.2 years; 52.9% female; 67.8% white) were analyzed. Dr. McCoy and colleagues found an all-cause 30-day readmission rate of 10.8%.

The most common cause of index hospitalization (5.5%) and readmission (8.9%) was heart failure, while severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified), and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, and 0.7% unspecified).

The risk factors that were the most likely to predispose patients to severe dysglycemia compared with other readmissions included younger age, severe dysglycemia at index or previous hospitalization, and the Diabetes Complications Severity Index (DCSI).

Other independent risk factors for other-cause readmissions included previous episodes of severe dysglycemia and the DCSI.

“We were especially concerned to find that, for patients whose index hospitalization was because of severe dysglycemia if they were readmitted within 30 days, it was very likely to be for another dysglycemia event. Nearly 30% experienced back-to-back dysglycemia, rather than readmission for any other cause,” she said.

“Severe dysglycemic events can be prevented with good diabetes outpatient care and careful discharge planning for diabetic patients who have been hospitalized for any reason, not just for severe hypoglycemia or hyperglycemia,” added Dr. McCoy.

For hospitalized diabetic patients, clinicians should develop discharge plans to include follow-up care with primary care providers immediately after discharge, during which clinicians should discuss the reasons for hospitalization with the patient, as well as their diabetes management.

“The hospital follow-up visit allows patients and their providers to discuss the reason for hospitalization, any medication changes, their ability to take care of themselves at home, and potential ways to prevent readmission if problems arise in the future,” noted Dr. McCoy. “It also provides an opportunity to review the patient’s diabetes management plan and blood sugar levels.”

She concluded: “Patients can do their part by learning to recognize severe dysglycemic episodes when they happen and reporting events to their care providers. They can work with their care providers to develop a plan on how to manage dysglycemia early, so symptoms don’t become so severe as to require hospitalization.”

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