Diabetes Complications Increase Readmission Risk

Jennifer Thew, RN, July 11, 2017

Despite their initial reason for hospitalization, diabetic patients with uncontrolled blood sugar are at risk for repeat admissions.

Diabetic patients with severe dysglycemia (uncontrolled high blood sugar or low blood sugar), are at increased risk for hospital readmission, despite their initial reason for hospitalization reports a new study in the Journal of General Internal Medicine.  

When a team of researchers, examined the data of over 340,000 adult diabetic patients hospitalized between January 2009 and December 2014, they determined patients with diabetes are initially admitted to the hospital and experience unplanned readmissions for a wide range of reasons with heart failure being the most common.  

Yet, once their initial condition was treated or stabilized, 10.8% were readmitted within 30 days of discharge and 2.5% of those readmissions were for dysglycemia regardless of the initial reason for hospitalization.

If their index hospitalization was also for severe dysglycemia, the risk of a recurrent episode requiring hospitalization was nearly nine times higher after a severe hyperglycemic event and five times higher after a severe hypoglycemic event. Patients between 18 and 44 years old were twice as likely to be readmitted for severe dysglycemia than older patients.

“We were especially concerned to find that, for patients whose index hospitalization was because of severe dysglycemia, if they were readmitted within 30 days, it was very likely to be for another dysglycemia event. Nearly 30% experienced back-to-back dysglycemia, rather than readmission for any other cause,” says the study’s lead author Rozalina McCoy, MD, an internal medicine physician and endocrinologist at Mayo Clinic in a news release.

Patient Education is Key to Prevention

Identifying patients at risk for readmission and intervening both during hospitalization and post-discharge can help prevent repeat hospitalizations, says McCoy.

“Severe dysglycemic 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,” she says. “Inpatient diabetes education has been shown to reduce risk of readmission, as have medication reviews, care transition programs, and other efforts to incorporate diabetes care into discharge planning and post hospital follow-up.”

No matter the initial reason for hospitalization, McCoy encourages healthcare providers of hospitalized diabetic patients to develop discharge plans that include follow-up with their primary care provider immediately after discharge. They should also discuss the reasons for the patient’s hospitalization and diabetes management.

“The hospital follow-up visit allows patients and their providers to discuss the reason for hospitalization, any medication changes, their ability to take care of themselves at home, and potential ways to prevent readmission if problems arise in the future,” she says. “It also provides an opportunity to review the patient’s diabetes management plan and blood sugar levels.”

Jennifer Thew, RN

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders Media.

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