Diabetic patients with hypoglycemia on the last day of hospitalization had higher readmission rates and postdischarge mortality.
Inpatient hypoglycemia worsens outcomes among patients with and without diabetes; however, little is known about the implications of low blood glucose levels during the last 24 hours of hospitalization. To evaluate whether hypoglycemia near the end of a hospitalization predicts subsequent adverse outcomes, researchers performed a retrospective cohort study of >800,000 diabetic U.S. Veterans Affairs patients.
Compared with patients whose blood glucose was 100 mg/dL to 109 mg/dL on the day before discharge (the referent category), patients with hypoglycemia (blood glucose, <70 mg/dL) in the 24 hours prior to discharge (9.1% of admissions) had significantly higher adjusted 30-day readmissions (13.7% vs. 18.5%; adjusted relative risk, 1.2), 30-day mortality (1.3% vs. 1.8%; aRR, 1.4), and 180-day mortality (6.9% vs. 8.7%; aRR, 1.3). Even low-normal blood glucose levels (70–93 mg/dL) were associated with higher 30-day readmission rates.
Hypoglycemia and low-normal glucose levels in diabetic patients near the time of hospital discharge might serve as a warning that something is awry. Delaying discharge, adjusting outpatient antidiabetic medications — and avoiding overly intensive inpatient glycemic control that leads to hypoglycemia in the first place — all are prudent strategies to improve outcomes.
Spanakis EK et al. Association of glucose concentrations at hospital discharge with readmissions and mortality: A nationwide cohort study. J Clin Endocrinol Metab 2019 Sep 1; 104:3679. (https://doi.org/10.1210/jc.2018-02575)
Neil H. Winawer, MD, SFHM reviewing