Original ArticleRelationship Between Glycemic Control and Readmission Rates in Patients Hospitalized With Congestive Heart Failure During Implementation of Hospital-Wide Initiatives
Section snippets
INTRODUCTION
Mixed results from randomized controlled trials in the intensive care unit (ICU) (1., 2., 3.) have triggered appeals for focused efforts to identify patient populations and disease states that are associated with increased risk of hyperglycemia-mediated harm (4). A large retrospective study demonstrated that the magnitude of the relationship between hyperglycemia and mortality depends on the admission diagnosis, with cardiac patients generally showing the highest risk (5). In the case of
METHODS
Hospital admissions between January 1, 2005, and December 31, 2006, were searched by using the Ohio State University Information Warehouse, a computerized data analysis tool that validates, cleanses, and deidentifies patient information incorporated from multiple electronic sources. Patients with a primary discharge diagnosis of CHF (defined as an International Classification of Diseases, Ninth Revision [ICD-9] code of 428.0) were identified (N = 1, 144). Only patients having a hospital length
Glycemic Variables
The primary glucose variables of interest were the total time-weighted mean glucose (TWMG), calculated as the area under the curve for glucose with use of the trapezoidal rule divided by the total time in hours, and the glycemic lability index (GLI), also corrected for time. Time-weighting, which has been described previously (3), was performed because the intervals between glucose measurements were nonuniform. Serum glucose values were excluded in order to maintain homogeneity in glucose
RESULTS
A total of 748 patients and 9, 236 glucose measurements (mean, 12.3 per patient) were included in the final analysis. The overall frequency of glucose monitoring was variable, with 94% of patients having at least 1 reading per day but only 11% having more than 3 readings per day when averaged for the entire hospital stay. A summary of demographic and clinical information is presented in Table 1. The mean glucose value was 137 ± 44.7 mg/dL, and 34.9% of patients experienced hypoglycemia (BG
DISCUSSION
The current study demonstrates that increased TWMG and A1C are associated with intermediate (30 to 90 days) but not short-term (< 30 days) readmission rates in patients with CHF, after adjustment for other important variables (Table 4). This relationship was observed despite otherwise acceptable glycemic control (18). It is possible that inpatient glycemic control is simply a surrogate for long-term glycemia (as determined by A1C), particularly because short-term readmission rates were unrelated
CONCLUSION
In summary, total glycemic exposure, but not GV, is related to higher intermediate-term readmission rates in patients with CHF. Prospective studies are needed to determine whether patients with CHF would benefit from improved glycemic control.
DISCLOSURE
The authors have no multiplicity of interest to disclose.
ACKNOWLEDGMENT
We thank the Ohio State University Information Warehouse and the Ohio State University Clinical Research Center (Award Number UL1RR025755 from the National Center for Research Resources) for assistance with data collection and analysis. This research was also supported by the National Institutes of Health grant 1K23DK080891-02. Parts of the data were presented in poster form at the 68th American Diabetes Association Scientific Sessions; June 6-10, 2008; San Francisco, California.
REFERENCES (27)
- et al.
Evidence for strict inpatient blood glucose control: time to revise glycemic goals in hospitalized patients
Metabolism
(2008) - et al.
Association of poor glycemic control with prolonged hospital stay in patients with diabetes admitted with exacerbation of congestive heart failure
Endocr Pract
(2004) - et al.
Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE)
Am Heart J
(2005) - et al.
Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options
Am J Med
(2008) - et al.
Prognostic factors in patients admitted with type 2 diabetes in internal medicine services: hospital mortality and readmission in one year (DICAMI study) [in Spanish]
Rev Clin Esp
(2007) - et al.
Quality of care and outcomes among patients with heart failure and chronic kidney disease: a Get With the Guidelines-Heart Failure Program study
Am Heart J
(2008) - et al.
Intensive insulin therapy in critically ill patients
N Engl J Med
(2001) - et al.
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
J Clin Endocrinol Metab
(2002) - et al.
Intensive versus conventional glucose control in critically ill patients
N Engl J Med
(2009) - et al.
Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis
Crit Care Med
(2009)
Effect of strict glycemic control on clinical state and course of the disease in patients with chronic heart failure and type II diabetes mellitus: results of the REMBO "rational effective multicomponent therapy in the struggle against diabetes mellitus in patients with congestive heart failure" study [in Russian]
Kardiologiia
Heart Disease and Stroke Statistics-2005 Update
Revisiting readmissions—changing the incentives for shared accountability
N Engl J Med
Cited by (25)
The Association of Diabetes and Hyperglycemia on Inpatient Readmissions
2021, Endocrine PracticeThe circle of care in diabetes: From home to hospital to home
2018, Endocrine PracticeThe effect of diabetes case management and Diabetes Resource Nurse program on readmissions of patients with diabetes mellitus
2017, Journal of Clinical and Translational Endocrinology