Influence of Ethnicity on Outcomes of Diabetes Inpatient Hypoglycemia: an Australian Perspective

Abstract

Aims To evaluate outcomes of diabetic inpatient hypoglycemia among Aboriginal and Torres Strait Islander (ATSI) compared with Australian Caucasian patients. Methods A retrospective audit of diabetic patients aged > 18 years admitted at a regional hospital general ward between April 1, 2015, and March 31, 2016, was analyzed. The database contains clinical information at the time of admission and initial discharge and readmission within 4 weeks thereafter. Results A total of 1618 (of 6027) patients were admitted with diabetes representing 23.7% of the total ward admissions, of which 484 (29.9%) had inpatient hypoglycemia. Of the 91 patients with available data analyzed, ATSI origin with inpatient hypoglycemia was associated with longer length of stay (LOS) (hazard ratio [HR], 2.1, 95% confidence interval [CI], 1.2-3.5), whereas severe hypoglycemia (≤ 2.2 mmol/L) in both ATSI and non-ATSI was significantly associated with longer LOS (HR, 2.3; 95% CI, 1.2-4.2). No significant differences in LOS were found for gender, age, and Carlson comorbidity index (CCI). The adjusted model for likelihood of readmission, gender, indigenous status, and CCI were not significant risk factors for readmission to the hospital. Readmitted patients were older (50-59 years vs < 50 years, P = 0.001; 60-69 years vs < 50 years, P = 0.032; 70+ years vs < 50 years, P = 0.031). Conclusion We reported high rate of inpatient hypoglycemia in our study population. Indigenous Australian diabetic patients with inpatient hypoglycemia had significantly longer LOS compared with non-Indigenous Caucasian counterparts. Further prospective studies on a larger population are needed to confirm our findings.

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

“…Reports from international registries revealed that extended LOS was independently associated with a history of comorbidities such as diabetes, heart disease, and hypertension, which were correlated with improved selected outcomes [15,16]. Our ndings are in consistent with earlier reports that comorbidity is one of the risk factors.…”

A prospective six-month audit of inpatient hypoglycemia in step-down general medical and geriatric wards

“…Although conditions associated with a marked increase in hypoglycemia risk were excluded due to prior AMU stabilization, the patients with documented hypoglycemia accounted for 7.2% of all bed-days on the audited wards. This is greater than the estimated equivalent figure of 3.8% to 7.0% for all Australian inpatients with at least one documented BGL ≤3.9 mmol/L [6][7][8]. Most of the present patients experienced only a single episode, but a disproportionate number of events occurred overnight, most were not associated with typical symptoms, and approaching one third were Level 2.…”

“…Patients with hypoglycemia contributed less to total bed days on the geriatric compared with the general medical wards. Because of their clinical complexity, general medical inpatients in the present audit were likely to have been older than in previous Australian studies [6,7]. Their relatively high hypoglycemia rate could reflect this since age is a recognized risk factor for inpatient hypoglycemia [3].…”

“…Although exclusion criteria such as critical illness ensure that inpatients at abnormally high risk do not bias estimates, available data still include people admitted because of hypoglycemia or with acute non-critical conditions associated with glycemic instability [4][5][6][7]. The burden of hypoglycemia in stabilized patients may differ from that in the general inpatient population, especially since the introduction of the Acute Medical Unit (AMU) has improved short-term outcomes including early discharge [9].…”

“…Contemporary Australian data using the same biochemical threshold appear similar. Although utilizing a denominator of inpatients with known or newly-detected diabetes, the 16.0% 6 and 29.9% 7 of this sub-group experiencing hypoglycemia equates to between 3.8% and 7.0% of all inpatients assuming that approaching 1 in 4 of hospitalized Australians have diabetes 7 , 8 .…”