Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions

Abstract

ObjectiveHypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission.Research design and methods4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes.Results1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of all-cause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25–34 and 35–44 (OR 2.334 and 1.996, respectively, compared with age 65–74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35–44 (OR 3.484, compared with age 65–74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017).ConclusionsFactors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and respiratory-related comorbid conditions.

Ethnic variations in the risk of hypoglycaemia among people with Type 2 diabetes prescribed insulins and/or sulfonylureas: a historical cohort study using general practice‐recorded data

“…Our findings are also consistent with studies of people with diabetes in North America, which have found African-American people to be at higher risk of hypoglycaemia than white European people [6,7,20,21]. Karter et al [8] performed a 7-year longitudinal study in people with Type 1 or ª 2018 Diabetes UK Type 2 diabetes prescribed insulin and/or sulfonylureas and found that African American people had consistently higher rates of severe hypoglycaemia than white Europeans, while Latino and Asian people had lower rates.…”

“…Our findings are also consistent with studies of people with diabetes in North America, which have found African‐American people to be at higher risk of hypoglycaemia than white European people . Karter et al .…”

National Estimates of 30-Day Unplanned Readmissions of Patients on Maintenance Hemodialysis

“…This contributes to the overall economic burden, because inpatient costs account for approximately 40% of total Medicare expenditures for dialysis. Although national epidemiology of unplanned readmissions has been described in other diseases, there are limited data on patients with ESRD on HD, especially those with non-Medicare insurance (2,3).…”

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

“…[1][2][3]8,9 Several studies focused on hospitalizations for hypoglycemia 8,10 or hyperglycemia, 8 but without placing them in the broader context of hospitalizations and readmissions. Severe dysglycemic events can be avoided with optimal transitional and ambulatory care, 11 and…”