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Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes

OBJECTIVE: To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes. RESEARCH DESIGN AND METHODS: A comprehensive list of clinical, pharmacy and utilization files were obtained from...

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Autores principales: Spanakis, Elias K, Singh, Lakshmi G, Siddiqui, Tariq, Sorkin, John D, Notas, George, Magee, Michelle F, Fink, Jeffrey C, Zhan, Min, Umpierrez, Guillermo E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222883/
https://www.ncbi.nlm.nih.gov/pubmed/32398351
http://dx.doi.org/10.1136/bmjdrc-2019-000990
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author Spanakis, Elias K
Singh, Lakshmi G
Siddiqui, Tariq
Sorkin, John D
Notas, George
Magee, Michelle F
Fink, Jeffrey C
Zhan, Min
Umpierrez, Guillermo E
author_facet Spanakis, Elias K
Singh, Lakshmi G
Siddiqui, Tariq
Sorkin, John D
Notas, George
Magee, Michelle F
Fink, Jeffrey C
Zhan, Min
Umpierrez, Guillermo E
author_sort Spanakis, Elias K
collection PubMed
description OBJECTIVE: To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes. RESEARCH DESIGN AND METHODS: A comprehensive list of clinical, pharmacy and utilization files were obtained from the Veterans Affairs (VA) Central Data Warehouse to create a nationwide cohort including 1 042 150 admissions of patients with diabetes over a 14-year study observation period. Point-of-care glucose values during the last 24 hours of hospitalization were extracted to calculate GV (measured as SD and coefficient of variation (CV)). Admissions were divided into 10 categories defined by progressively increasing SD and CV. The primary outcome was 30-day readmission rate, adjusted for multiple covariates including demographics, comorbidities and hypoglycemia. RESULTS: As GV increased, there was an overall increase in the 30-day readmission rate ratio. In the fully adjusted model, admissions with CV in the 5th–10th CV categories and admissions with SD in the 4th–10th categories had a statistically significant progressive increase in 30-day readmission rates, compared with admissions in the 1st (lowest) CV and SD categories. Admissions with the greatest CV and SD values (10th category) had the highest risk for readmission (rate ratio (RR): 1.08 (95% CI 1.05 to 1.10), p<0.0001 and RR: 1.11 (95% CI 1.09 to 1.14), p<0.0001 for CV and SD, respectively). CONCLUSIONS: Patients with diabetes who exhibited higher degrees of GV on the final day of hospitalization had higher rates of 30-day readmission. TRIAL REGISTRATION NUMBER: NCT03508934, NCT03877068.
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spelling pubmed-72228832020-05-15 Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes Spanakis, Elias K Singh, Lakshmi G Siddiqui, Tariq Sorkin, John D Notas, George Magee, Michelle F Fink, Jeffrey C Zhan, Min Umpierrez, Guillermo E BMJ Open Diabetes Res Care Epidemiology/Health Services Research OBJECTIVE: To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes. RESEARCH DESIGN AND METHODS: A comprehensive list of clinical, pharmacy and utilization files were obtained from the Veterans Affairs (VA) Central Data Warehouse to create a nationwide cohort including 1 042 150 admissions of patients with diabetes over a 14-year study observation period. Point-of-care glucose values during the last 24 hours of hospitalization were extracted to calculate GV (measured as SD and coefficient of variation (CV)). Admissions were divided into 10 categories defined by progressively increasing SD and CV. The primary outcome was 30-day readmission rate, adjusted for multiple covariates including demographics, comorbidities and hypoglycemia. RESULTS: As GV increased, there was an overall increase in the 30-day readmission rate ratio. In the fully adjusted model, admissions with CV in the 5th–10th CV categories and admissions with SD in the 4th–10th categories had a statistically significant progressive increase in 30-day readmission rates, compared with admissions in the 1st (lowest) CV and SD categories. Admissions with the greatest CV and SD values (10th category) had the highest risk for readmission (rate ratio (RR): 1.08 (95% CI 1.05 to 1.10), p<0.0001 and RR: 1.11 (95% CI 1.09 to 1.14), p<0.0001 for CV and SD, respectively). CONCLUSIONS: Patients with diabetes who exhibited higher degrees of GV on the final day of hospitalization had higher rates of 30-day readmission. TRIAL REGISTRATION NUMBER: NCT03508934, NCT03877068. BMJ Publishing Group 2020-05-11 /pmc/articles/PMC7222883/ /pubmed/32398351 http://dx.doi.org/10.1136/bmjdrc-2019-000990 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Epidemiology/Health Services Research
Spanakis, Elias K
Singh, Lakshmi G
Siddiqui, Tariq
Sorkin, John D
Notas, George
Magee, Michelle F
Fink, Jeffrey C
Zhan, Min
Umpierrez, Guillermo E
Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title_full Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title_fullStr Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title_full_unstemmed Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title_short Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
title_sort association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
topic Epidemiology/Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222883/
https://www.ncbi.nlm.nih.gov/pubmed/32398351
http://dx.doi.org/10.1136/bmjdrc-2019-000990
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