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Hospital readmission common among adults with primary, secondary diabetes diagnosis

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July 27, 2017

A primary or secondary diabetes diagnosis increases the risk for hospital readmission, and adults with a primary diabetes diagnosis are likely to be readmitted for diabetes-related causes, according to a study.

Roma Gianchandani, MD, associate professor in the division of metabolism, endocrinology and diabetes at the University of Michigan in Ann Arbor, and colleagues evaluated two separate sets of patient data to determine the incidence and causes of 30-day readmission rates for adults with diabetes listed as either the primary reason for index admission or with diabetes listed as the secondary diagnosis vs. adults without diabetes, and to determine the effect on readmission of two specialized inpatient diabetes services.

The diabetes services included the Hyperglycemic Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO).

The first study included 7,763 admissions of patients with a principal or secondary admission diagnosis of diabetes admitted to any adult service within the University of Michigan Health System between Oct. 1, 2013, and Dec. 31, 2013. Overall, 97.3% of patients were discharged alive, and 25% had a diagnosis of diabetes before admission.

Thirty-day readmission rates were higher among participants with any diagnosis of diabetes on index admission (26.4%) compared with participants without diabetes (22.6%; P < .001). Participants with a primary or a secondary diagnosis of diabetes had higher inpatient readmission rates (18%) compared with participants without diabetes (13.7%). Readmission rates were 40.5% for participants with a primary diagnosis of diabetes, 25.8% for participants with a secondary diagnosis of diabetes and 22.5% for participants with no known diagnosis of diabetes.

Researchers also evaluated only participants with a primary diagnosis of diabetes (n = 121; mean age, 50 years; 67% with acute or chronic renal disease). Among these participants, 30% were admitted for a surgical procedure, 95% received insulin while in the hospital, 28% were seen by either the HIIP or ENDO service for diabetes management and 26% were readmitted for a diabetes-related reason.

The second study included 37,702 discharges between Oct. 1, 2013, and Sept. 30, 2014, at the University of Michigan Health System with a principal or secondary discharge diagnosis of diabetes. Overall, 21% had known diabetes before admission.

Participants with diabetes had higher readmission rates for all encounters, including inpatient, ED and observation care (24.5%), compared with participants without diabetes (17.7%; P < .001), and 30-day readmission rates were also higher (17.5% vs. 9.3%). Readmission for all three encounter types was more likely among participants with diabetes compared with participants without diabetes (P < .001). A diabetes service consult was received by 12% of participants with diabetes during the index hospital stay. The ED/observation readmission rate was lower in participants followed by the diabetes services compared with participants without the services (P = .0012). However, there was no difference in inpatient readmission rates in participants with a diabetes consult compared with those without a diabetes consult.

“Patients with a primary and secondary diagnosis of [diabetes] have higher readmission rates than patients without known [diabetes],” the researchers wrote. “Reasons for readmission varied, those with a principal admitting diagnosis having more readmissions with diabetes-related issues while those with a secondary admitting diagnosis of diabetes having more infection-related readmissions. [Diabetes] services were utilized in a very small proportion of patients with [diabetes] and may have contributed to lower ED revisits by providing more robust diabetes management, discharge planning and instruction. Their impact on readmission in prospective studies needs to be evaluated.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.