Low blood sugar during discharge increases death and hospital readmission

USA: A nationwide, retrospective cohort study of 843,978 admissions of diabetic patients found that the diabetes patients having low blood sugar (hypoglycemia) or near normal glucose levels during the last day of hospitalization are at higher risk for death after discharge and readmission to the hospital within 30 days of the discharge.

Results of the study are published in The Journal of Clinical Endocrinology and Metabolism.

Previous studies have demonstrated that low blood glucose concentrations during the discharge day may affect 30-day readmission and post-hospital discharge mortality rates. Elias K Spanakis, Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA, and colleagues conducted the study to investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk of readmission or mortality.

The study involved analysis of 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals over a 14-year period. The minimum point of care glucose values were collected during the last 24 hours of the hospitalization. adjusted rates of 30-day readmission rate, 30-day, 90-day, and 180-day mortality rate and combined 30-day readmission/mortality rate were used to identify minimum glucose thresholds above which patients can be safely discharged.

Main outcomes of the study were 30-day readmission rate, 30-day, 90-day, and 180-day mortality rate and combined 30-day readmission/mortality rate.

The researchers found that:

• The rate ratios (RR) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90-99 mg/dl category, compared to the 100-109 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 1.03 to 1.91.


• Patients with diabetes experienced greater 30-day readmission rate, 30-, 90- and 180-day post-discharge mortality and higher combined 30-day readmission/mortality with glucose levels <92.9 mg/dl, <45.2 mg/dl, 65.8 mg/dl and 67.3 mg/dl and <87.2 mg/dl, respectively.

"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 post-discharge mortality," concluded the authors.

For detailed study log on to https://doi.org/10.1210/jc.2018-02575