Diabetes Increases Hospital Readmissions Rates

Patients with diabetes have higher rates of hospital readmission compared with patients without diabetes, according to a pilot study published in Clinical Diabetes and Endocrinology.

Researchers from the University of Michigan in Ann Arbor conducted 2 studies using different datasets. The first was a retrospective review of all patients admitted (n=7763) to any adult service within the University of Michigan Health System with a principal or secondary admission diagnosis of diabetes followed by an uncontrolled analysis of patients with a principal admission diagnosis of diabetes. The second analysis was a larger retrospective study (n=37,702) of all adults discharged from the University of Michigan Health System with a principal or secondary discharge diagnosis of diabetes.

In the first study, the readmission rate was 26% in patients with diabetes vs 22% in patients without diabetes. The most common cause for readmission was diabetes-related in patients with a principal diagnosis of diabetes on index admission, whereas the most common cause for readmission in patients with a secondary diagnosis of diabetes was infection-related. 

Of the patients with diabetes, approximately only 12% received any type of diabetes service consult (eg, Hyperglycemic Intensive Insulin Program [HIIP] or Endocrine Consults [ENDO]). Patients who received diabetes services had lower rates of emergency department and observation readmissions (6.6% HIIP or ENDO vs 9.6% no HIIP or ENDO; P =.0012), although there were no differences in the inpatient readmission rates (17.6% HIIP or ENDO vs 17.4% no HIIP or ENDO; P =.89). 

“[Diabetes] services were utilized in a very small population of patients with [diabetes] and may have contributed to lower [emergency department] revisits by providing more robust diabetes management, discharge planning and instruction,” the researchers wrote. “Their impact on readmission in prospective studies needs to be evaluated.”

Study Limitations

• The study was retrospective in nature; patient data were derived from data warehouse and chart review.
• Patients who had known diabetes, but did not have a “billing diagnosis” of diabetes, were not included, and therefore, not all patients with diabetes may have been captured.
• The 2 diabetes consult groups, HIIP and ENDO, service different patient populations. 
• These data were collected from 1 academic institution and may not be generalizable to patients elsewhere.

Reference

Ostling S, Wyckoff J, Ciarkowski SL, et al. The relationship between diabetes mellitus and 30-day readmission rates [published online March 22, 2017].Clin Diabetes Endocrinol. doi:10.1186/s40842-016-0040-x