![]() ![]() 19 20 p Values <0.05 were defined to be statistically significant. The t test for means or the z-test for proportions were used to derive p values, after adjusting for the within-participant correlation for patients with multiple encounters. Findings were stratified by readmission type and were reported as either proportions for binary variables, or means and SDs or medians and IQRs for continuous variables. The primary end point was all-cause readmission to the ER/hospital within 30 days, and the secondary end point was hypoglycemia-related readmission within 30 days with hypoglycemia defined as above (ie, a primary diagnosis of 251.0 or 251.1 or a primary diagnosis of 250.3 and a secondary diagnosis of 251.0, 251.1, or 251.2 without a secondary diagnosis of 249.1x or 250.1x). ![]() 18 Patients could have more than one study encounter, but encounters with a discharge disposition of expired or unknown at the time of the first encounter were excluded, such that only surviving patients were included in the study for follow-up. Comorbid conditions were defined by 2014 Healthcare Cost and Utilization Project Clinical Classifications Software (HCUP CCS). Patients with an ER visit immediately preceding the in-pt encounter were counted as in-pts, and their ER data were merged to create one hospital encounter. 17 In this study, we characterize hospital ER/hospital admissions related to hypoglycemia and identify risk factors for 30-day ER/hospital readmission using a large, contemporary multicenter database.Ī primary diagnosis of diabetes with other coma (250.3) AND a secondary diagnosis of hypoglycemic coma (251.0), other unspecified hypoglycemia (251.1), or hypoglycemia unspecified (251.2) WITHOUT a secondary diagnosis of secondary diabetes mellitus with ketoacidosis (249.1x) or diabetes with ketoacidosis (250.1x).Įxclusion criteria were pregnancy, lack of at least one blood glucose laboratory value during the study encounter or transfer from an acute care facility. ![]() Thirty-day readmission has become an important hospital performance measure used by the Centers for Medicare & Medicaid Services. 15 16 However, the risk factors associated with 30-day readmission to the ER or hospital (ER/hospital) after a hypoglycemia-related ER or hospital admission have not been well established. Prior studies on hospital-based ER and inpatient (in-pt) admissions for hypoglycemia have largely focused on a specific treatment setting, diabetes type, age group, or geographic region. 12 13 Further, research indicates that fear of hypoglycemic events reduces adherence to prescribed antidiabetic regimens. 10 Although only a portion of severe hypoglycemic episodes present to the emergency room (ER) or hospital, 11 resource utilization related to these events reflect the significant burden on the healthcare system. Severe hypoglycemia in diabetes is defined as an event requiring the assistance of others. Hypoglycemia may contribute to the risk of cardiovascular events 1–3 and is associated with increased morbidity and mortality. Typical causes of hypoglycemia in patients with diabetes include use of insulin or diabetes medications, missed meals or inadequate caloric intake, and alcohol consumption. ![]() Hypoglycemia is a common, serious complication of diabetes treatment. Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). 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). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. 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). 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. ![]()
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