A nationwide cohort study conducted in the US assessed whether people with diabetes who had with low blood glucose concentrations at the time of hospital discharge were at a higher risk of 30-day readmission or mortality. The study included 843,978 diabetic patients admitted at Veteran Affairs hospitals over 14 years. Outcomes assessed included 30-day readmission, 30-day readmission/mortality rate and 30-, 90-, and 180-day mortality rates. As minimum glucose concentrations dropped from the 100-109 mg/dL (5.6 – 6.1 mmol/L) category to the 90-99 mg/dL (5.0 – 5.5 mmol/L) category, rate ratios (RR) increased for each of the outcomes:
- 30-day readmission RR: increased from 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 RR: 1.03 to 1.91
The threshold BGL for higher risk of outcomes increased risk of readmission within 30 days was observed at <92.9 mg/dL (5.2 mmol/L), whereas increased risk for all-cause mortality at 30 days was seen at 65.8 mg/dL (3.7 mmol/L). The take home message is that low BGL at discharge is associated with greater rates of serious complications. The study, which can be viewed here, concludes that there is a need for prospective studies to underpin safer discharge approaches for diabetic patients with low blood glucose concentrations, to decrease readmission and mortality among this population.
Contributed by Australian Medication Safety Services Associate – Isabella Singh