Relationship between glycemic control and readmission rates in patients hospitalized with congestive heart failure during implementation of hospital-wide initiatives.
OBJECTIVE
To determine the relationship between inpatient glycemic control and hospital readmission in patients with congestive heart failure (CHF).


METHODS
We used an electronic data collection tool to identify patients with a discharge diagnosis of CHF who underwent point-of-care glucose assessments. Timeweighted mean glucose (TWMG), hemoglobin A1c, and glycemic lability index (GLI) served as glycemic indicators, and readmission for CHF was determined at 30 days and between 30 and 90 days.


RESULTS
The analysis included 748 patients. After adjustment for significant covariates, log-transformed increasing TWMG (odds ratio 3.3; P = .03) and log-transformed hemoglobin A1c (odds ratio 5.5; P = .04) were independently associated with higher readmission for CHF between 30 and 90 days, but not by 30 days. Renal disease, African American race, and year of hospital admission were also significantly associated with readmission, but GLI was not. There was no significant difference in TWMG when analyzed on the basis of race or renal status. We noted a decrease in TWMG (P = .004) and a trend for reduction in readmission rates between 30 and 90 days (P = .06) after hospital-wide interventions were implemented to improve glycemic control, but no significant difference was detected in GLI or hypoglycemia.


CONCLUSIONS
Increasing glucose exposure, but not glycemic variability, was associated with higher risk of readmission between 30 and 90 days in patients with CHF. Prospective studies are needed to confirm or refute these results.
Dungan
Kathleen M
KM
Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA. Kathleen.dungan@osumc.edu
Osei
Kwame
K
Nagaraja
Haikady N
HN
Schuster
Dara P
DP
Binkley
Philip
P
D000368:Aged; D001786:Blood Glucose; D005260:Female; D038321:Glycemic Index; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*
D001786:Blood Glucose