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Intensification of diabetes medication and risk for 30‐day readmission
Author(s) -
Wei N. J.,
Wexler D. J.,
Nathan D. M.,
Grant R. W.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12061
Subject(s) - medicine , emergency department , odds ratio , diabetes mellitus , emergency medicine , insulin , regimen , type 2 diabetes , endocrinology , psychiatry
Aim To examine the association of in‐hospital diabetes regimen intensification with subsequent 30‐day risk for unplanned readmission/emergency department admission. Methods We retrospectively studied 1949 adults with Type 2 diabetes receiving primary care within an academic health network admitted to the hospital between January 2007 and December 2009. Glucose therapy intensification was defined as new start of insulin or oral hypoglycaemic agents, or addition of prandial insulin or insulin mixtures. The association of glucose therapy intensification with subsequent 30‐day risk for unplanned readmission/emergency department admission was examined, with focus on medicine service patients with poorly controlled glycaemia (baseline HbA 1c ≥ 64 mmol/mol). Results One in six patients (324/1949, 17%) had early readmission/emergency department admission. Compared with patients without early readmission, readmitted patients were more often male (58 vs. 52%, P = 0.03), had higher Charlson co‐morbidity score [mean ( sd ) 3.0 (2.0) vs. 2.8 (1.8), P = 0.02], longer length of stay [5 (4.4) vs. 3.9 (3.3) days, P < 0.01] and were more often discharged home with nursing services (38 vs. 32%, P = 0.03). Overall, glucose therapy intensification was not associated with early hospital readmission/emergency department admission (odds ratio 0.94, 95% CI 0.64–1.37, P = 0.74). However, among medicine service patients with baseline HbA 1c ≥ 64 mmol/mol (8%), glucose therapy intensification was associated with a significantly decreased early readmission risk (adjusted odds ratio 0.33, 95% CI 0.12–0.88, P = 0.03) and lower post‐discharge HbA 1c {mean decrease ( sd ): 20 (26) mmol/mol [1.8 (2.4)%] vs. 7 (15) mmol/mol [0.6 (1.4)%], P < 0.01}. Conclusions Diabetes medical regimen intensification during hospitalization was not associated with early readmission. Among patients with elevated HbA 1c , glucose therapy intensification was associated with a decreased 30‐day readmission/emergency department admission risk and lower outpatient HbA 1c levels. Our findings support the safety and durable impact of diabetes regimen optimization during hospital admission.