The findings demonstrate why quality ratings focus heavily on managing diabetes and targeting 30-day readmission rates.
For patients with diabetes, uncontrolled blood sugar—either hyperglycemia or hypoglycemia—might account for a small share of hospital readmissions. But once patients return for this reason, there’s a strong chance they will be back again, according to new findings that appear in the Journal of General Internal Medicine.
Researchers from the Mayo Clinic led by Rozalina McCoy, MD, studied claims data for more than 342,000 patients with diabetes from OptumLabs. The patients were hospitalized more than 600,000 separate times between 2009 and 2014.
The data show that no matter the reason for their initial hospital visit, 10.8% of the patients ended up back in the hospital within 30 days—which shows why both diabetes and 30-day readmission measures are such core indicators of quality.
Dysglycemia—having blood glucose either too high or too low—accounted for 2.6% of the initial admissions, as well as 2.5% of the initial 68,212 readmissions. But, once readmitted for this reason, the risk of another episode requiring hospitalization increased 9-fold after hyperglycemia and 5-fold after hypoglycemia. Researchers found this extremely troubling.
“Severe dysglycemia events can be prevented with good diabetes outpatient care and careful discharge planning for diabetic patients who have been hospitalized for any reason—not just for severe hypoglycemia or hyperglycemia,” McCoy said in a statement.
Can this be avoided? McCoy said healthcare providers need to develop better discharge plans that include follow-up with primary care providers right after they leave the hospital. Those plans should cover not only the reason for the hospital stay, but diabetes management as well. Follow-up care offers a chance to review any medication changes, the diabetes management plan, and blood sugar levels, she said.
Besides offering more proof for the need to track how well health systems control diabetes and prevent 30-day readmissions, the new Mayo Clinic study pointed toward another trend in diabetes care: the need to prevent heart failure in these patients. The data showed congestive heart failure was the top cause for initial admission (5.5%). At the recent American Diabetes Association meeting, a symposium explored the connection between diabetes and heart failure, with the conclusion that more research is needed—but so far, it’s clear that patients with diabetes do worse than other patients.
Trials getting under way for empagliflozin will explore the sodium glucose co-transporter-2 (SGLT2) inhibitor’s benefits in preventing heart failure, both in patients with diabetes and those without.
McCoy RG, Lipska KJ, Herrin J, et al. Hospital readmissions among commercially insured and Medicare Advantage beneficiaries with diabetes and the impact of severe hypoglycemic and hyperglycemic events [published online July 7, 2017]. J Gen Intern Med. 2017; doi: 10.1007/s11606-017-4095-x.