Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes

Rozalina McCoy, Jeph Herrin, Kasia J. Lipska, Nilay D Shah

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2 Citations (Scopus)

Abstract

Aims: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes. Methods: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. Results: After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5–0.9 for 45–64 vs. <45 years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75 years (OR 13.3, 95% CI 2.4–73.4, vs. <45 years). Conclusions: Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events.

Original languageEnglish (US)
JournalJournal of Diabetes and its Complications
DOIs
StateAccepted/In press - Jan 1 2018

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Hypoglycemia
Hyperglycemia
Hospitalization
Comorbidity
Glucose

Keywords

  • Diabetes
  • Hospitalization
  • Hyperglycemic hyperosmolar state (HHS)
  • Hypoglycemia
  • Ketoacidosis (DKA)
  • Readmission

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

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title = "Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes",
abstract = "Aims: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes. Methods: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. Results: After 6419 index hypoglycemia hospitalizations, 1.2{\%} were readmitted for recurrent hypoglycemia, 0.2{\%} for hyperglycemia, and 8.6{\%} for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0{\%} were readmitted for recurrent hyperglycemia, 0.4{\%} for hypoglycemia, and 5.4{\%} for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95{\%} CI 0.5–0.9 for 45–64 vs. <45 years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95{\%} CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75 years (OR 13.3, 95{\%} CI 2.4–73.4, vs. <45 years). Conclusions: Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events.",
keywords = "Diabetes, Hospitalization, Hyperglycemic hyperosmolar state (HHS), Hypoglycemia, Ketoacidosis (DKA), Readmission",
author = "Rozalina McCoy and Jeph Herrin and Lipska, {Kasia J.} and Shah, {Nilay D}",
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AU - McCoy, Rozalina

AU - Herrin, Jeph

AU - Lipska, Kasia J.

AU - Shah, Nilay D

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N2 - Aims: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes. Methods: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. Results: After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5–0.9 for 45–64 vs. <45 years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75 years (OR 13.3, 95% CI 2.4–73.4, vs. <45 years). Conclusions: Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events.

AB - Aims: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes. Methods: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. Results: After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5–0.9 for 45–64 vs. <45 years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75 years (OR 13.3, 95% CI 2.4–73.4, vs. <45 years). Conclusions: Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events.

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