title: Long-term glycaemic control (HbA1c), not admission glucose, predicts hospital re-admission in diabetic patients.
abstract: BACKGROUND
  Diabetic patients are commonly hyperglycaemic on presentation. Admission hyperglycaemia is associated with adverse outcomes, particularly prolonged hospitalisation. Improving inpatient glycaemia may reduce length of hospital stay (LOS) in diabetic patients.
  
  
  OBJECTIVE
  To determine whether in-hospital recognition and treatment of admission hyperglycaemia in diabetic patients is associated with reduced LOS.
  
  
  METHODS
  Medical records were reviewed from 1 November 2011 to 31 May 2012 for 162 diabetic patients admitted with a blood glucose level (BGL) ≥11.1mmol/L. In-hospital outcomes were compared. Stepwise multiple regression was used to evaluate factors contributing to LOS.
  
  
  RESULTS
  Compared to the untreated individuals (n=67), hyperglycaemia treatment (n=95) was associated with a longer LOS (median eight vs. four days, p<0.01), higher HbA1c (9.0 vs. 7.3 per cent, p<0.01), more infections (50 vs. 25 per cent, p<0.01), and more patients with follow-up plans (35 vs. 10 per cent, p<0.01). Higher HbA1c was significantly related to more follow-up (ρs=0.30, n=110, p<0.01) with a trend to lower re-admission in those with follow-up plans (ρs=-1.41, n=162, p=0.07).
  
  
  CONCLUSIONS
  Recognition and treatment of admission hyperglycaemia in diabetic patients was associated with longer LOS than if untreated. Contributory factors to LOS include: illness severity, infections, and higher HbA1c. Although follow-up plans were few (27 per cent) for diabetic patients with hyperglycaemia, it was significantly more likely in those with higher HbA1c. Diabetic patients' complexities require timely multidisciplinary team involvement. Improved follow-up care, particularly for hospitalised diabetic patients identified to have chronically poor glycaemic control, may help prevent future diabetic patient re-admissions.
authors.affiliation: School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, NSW, Australia.
authors.forename: Thora Y
authors.initials: TY
authors.lastname: Chai
authors.affiliation: Department of Endocrinology, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Tonks
authors.affiliation: Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
authors.forename: Lesley V
authors.initials: LV
authors.lastname: Campbell
keywords: community management; diabetes mellitus; glycaemic control; hyperglycaemia