Dr. Andrew Zullo, assistant professor of health services, policy, and practice at Brown University School of Public Health, wrote a commentary on a recently published retrospective cohort study by McCoy et al. (2017). This study utilized administrative data from commercially insured and Medicare Advantage beneficiaries with diabetes to describe the relative frequency of hospital readmissions for severe dysglycemia (hypoglycemia and hyperglycemia) and other causes. It also examined potential predictors of such events.
[Photo: Dr. Andrew Zullo]
The authors found that all-cause 30-day readmission rate was 10.8 percent. Heart failure was the most common cause for readmission (8.9 percent), and severe dysglycemia accounted for 2.5 percent of readmissions (38.3 percent hyperglycemia, 61.0 percent hypoglycemia, 0.7 percent unspecified). Younger age, history of dysglycemia, and a higher Diabetes Complications Severity Index score were independent predictors of severe dysglycemia relative to other readmission causes.
Dr. Zullo writes that most studies of dysglycemia using administrative data have been limited to the assessment of severe events because mild-to-moderate events are (1) most likely to occur in settings outside of clinical care and (2) are unlikely to be recorded as justification for a clinical encounter or payment of health services. He then concludes that the epidemiology and consequences of mild-to-moderate dysglycemia are therefore unaddressed by this study and are much less well understood in the empirical literature.
He points out that future studies in large populations should strive to assess mild-to-moderate dysglycemia and build on administrative data by leveraging the information in electronic health records. Ultimately, these additional data will help to provide a more complete understanding of dysglycemia that best informs optimal transitional and ambulatory care practices and permits targeting of interventions to individuals with diabetes at highest risk. Additionally, studies of dysglycemia in frail older adults are acutely needed as data on the epidemiology and consequences of occurrence are lacking.
The article was published in the Journal of General Internal Medicine, Volume 32, in June.