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

Elias K Spanakis, Lakshmi G Singh, Tariq Siddiqui, John D Sorkin, George Notas, Michelle F Magee, Jeffrey C Fink, Min Zhan, Guillermo E Umpierrez, Elias K Spanakis, Lakshmi G Singh, Tariq Siddiqui, John D Sorkin, George Notas, Michelle F Magee, Jeffrey C Fink, Min Zhan, Guillermo E Umpierrez

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.

Keywords: epidemiology; hospitalization; inpatient diabetes management.

Conflict of interest statement

Competing interests: EKS has received research support from DEXCOM for the conduction of clinical studies, which did not support this work monetarily or in kind. 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.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study cohort creation flow diagram. BMI, body mass index; DM, diabetes mellitus; ICU, intensive care unit; LOS, length of stay; Psych, psychiatric.

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