Hypoglycemia Close to Discharge Is Associated with Worse Outcomes
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.
COMMENT
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.
CITATION(S):
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
da NEJM
