Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes

• Type of Material: Article
• Authors: Elias K. Spanakis, Baltimore Veterans Affairs Medical Center; Lakshmi G. Singh, Baltimore Veterans Affairs Medical Center; Tariq Siddiqui, University of Maryland; John D. Sorkin, Baltimore Veterans Affairs Medical Center; George Notas, University of Crete; Michelle F. Magee, Georgetown University; Jeffrey C. Fink, University of Maryland; Min Zhan, University of Maryland; Guillermo Umpierrez, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: MFM has recently completed an Eli Lilly funded outpatient Pharma trial, which did not support this work monetarily or in kind. GEU has received unrestricted research support for inpatient studies (to Emory University) from Sanofi, Novo Nordisk, and Dexcom, which did not support the work monetarily or in kind.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjdrc-2019-000990
• Title of Journal or Parent Work: BMJ Open Diabetes Research & Care
• Volume: 8
• Issue: 1
• Grant/Funding Information: MFM has received research support from the National Institutes of Health for an inpatient diabetes education study (R34 Planning Grant for Pragmatic Research in Healthcare settings, DK-109503, entitled Diabetes To Go Inpatient).; GEU is partly supported by research grants from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378, from the Clinical and Translational Science Award program and from the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK P30DK11102).; JDS was supported by National Institute of Aging (NIA P30-AG028747), National Institute of Diabetes and Digestive and Kidney Disease (NIDDK P30-DK072488) and the Baltimore VA Geriatric Research, Education and Clinical Center.; This work was supported in part by the VA MERIT award (#1I01CX001825-01) from the US Department of Veterans Affairs Clinical Sciences Research and Development Service (EKS) and by the Baltimore VA Patient Safety Center of Inquiry (JCF).
• Keywords: hospitalization; Longitudinal data analysis; inpatient diabetes management; Hyperglycemia; Science & Technology; Care; epidemiology; Hypoglycemia; Mortality; Rehospitalizations; Life Sciences & Biomedicine; Endocrinology & Metabolism; Length of stay; Risk factors; Glycemic variability; Management
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Objective: To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes. Research design and methods: A comprehensive list of clinical, pharmacy and utilization files were obtained from the Veterans Affairs (VA) Central Data Warehouse to create a nationwide cohort including 1 042 150 admissions of patients with diabetes over a 14-year study observation period. Point-of-care glucose values during the last 24 hours of hospitalization were extracted to calculate GV (measured as SD and coefficient of variation (CV)). Admissions were divided into 10 categories defined by progressively increasing SD and CV. The primary outcome was 30-day readmission rate, adjusted for multiple covariates including demographics, comorbidities and hypoglycemia. Results: As GV increased, there was an overall increase in the 30-day readmission rate ratio. In the fully adjusted model, admissions with CV in the 5th-10th CV categories and admissions with SD in the 4th-10th categories had a statistically significant progressive increase in 30-day readmission rates, compared with admissions in the 1st (lowest) CV and SD categories. Admissions with the greatest CV and SD values (10th category) had the highest risk for readmission (rate ratio (RR): 1.08 (95% CI 1.05 to 1.10), p<0.0001 and RR: 1.11 (95% CI 1.09 to 1.14), p<0.0001 for CV and SD, respectively). Conclusions: Patients with diabetes who exhibited higher degrees of GV on the final day of hospitalization had higher rates of 30-day readmission. Trial registration number NCT03508934, NCT03877068.