Patients with Diabetes Often Readmitted for Hypo- and Hyperglycemia

While hospital readmissions may be common for patients with diabetes, some readmissions may be avoided for hypoglycemia and hyperglycemia cases with better follow-up care, according to a new report.

Researchers from the Mayo Clinic conducted a retrospective analysis of more than 300,000 patients with diabetes discharged from hospitals to ascertain the most common reasons and risk factors for readmission. The adults were commercially insured and Medicare Advantage beneficiaries from across the United States and discharged from their respective hospitals between January 1, 2009, and December 31, 2014. The investigators counted all unplanned readmissions within 30 days of discharge as part of their study, and categorized dysglycemia (both hypo- and hyperglycemia) compared with all other causes.

There were nearly 600,000 index hospitalizations throughout the study period, of which 2.6% were for severe dysglycemia, the researchers reported. Causes between hypo- and hyperglycemia were about half and half; however there were 1.5% of cases that were unspecified dysglycemia. The most common cause for index hospitalization was heart failure (5.5% of patients). Dysglycemia was the 11^th most common cause of first hospitalization, the investigators learned.

The all-cause 30-day readmission rate was 10.8% among the adults with diabetes, and, among those patients, heart failure was the most common cause for readmission at 9%. Of the 2.5% of readmissions due to dysglycemia, it was split 60/40 among hypo- and hyperglycemia, respectively.

“We already knew that adults with diabetes carry a high risk for hospitalization and unplanned readmission,” the study’s lead author, Rozalina McCoy, MD, said in a press release. “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.”

One of the general risk factors for readmission, the study authors said, was longer length of stay during index hospitalization. African American patients appeared to have a slightly higher risk than white patients did, the researchers wrote. Additionally, readmission risk was lower after planned rather than unplanned hospital readmissions. Another factor that seemed to reduce the unplanned readmission risk included higher income.

Hospital readmissions specifically for dysglycemia in diabetic patients had its own set of risk factors, including patient age, Diabetes Complications Severity Index, index hospitalization for dysglycemia and prior history of dysglycemia hospitalizations. The risk in these patients was nearly twice as high among patients older than 45 years of age compared with those younger than 45 years of age. It did not appear to be a risk factor again until patients reached 75 years of age or older.

“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,” McCoy continued. “It also provides an opportunity to review the patient’s diabetes management plan and blood sugar levels.”

McCoy added that programs such as inpatient diabetes education, medication reviews, care transition programs, and other efforts to incorporate diabetes care into discharge planning and follow-up can be helpful in reducing the risk for readmission. If patients learn to recognize severe dysglycemic episodes when they occur, they can help their doctors develop personalized plans to manage the symptoms without the requirement of hospitalizations, she concluded.

The full report can be found in the Journal of General Internal Medicine.

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