High Glucose Variability Increases 30-Day Readmission Rates in Patients with Type 2 Diabetes Hospitalized in Department of Surgery

Abstract

Glucose variability is common among hospitalized patients with type 2 diabetes mellitus (DM). I investigated to assess the variability of glucose in patients with type 2 DM accounts for in-hospital readmission rates in department of Surgery. I retrospectively analyzed 206 patients with type 2 DM, who was admitted to our hospital for surgical interventions and re-admitted within 30 days after discharge. I also enrolled 610 age, sex and diabetic duration matched patients with type 2 DM, as control. Outcomes measure included average and standard deviation (SD) of blood glucose during admission, glycated hemoglobin (HbA1c), lipid profile, renal function, length of stay (LOS). Patients who had re-admission within 30 days after discharge had higher SD of blood glucose levels than control (84.7 ± 53.5 mg/dL vs. 46.2 ± 42.8 mg/dL, p < 0.001) but not average of blood glucose levels. Comparing to control group, the study group also had higher HbA1c (8.4 ± 1.3% vs. 7.7 ± 1.1%, p = 0.015) and LOS (8.5 ± 2.5 days vs 7.0 ± 1.5 days, p = 0.020). The independent predictors of 30-day readmission rates were SD of blood glucose during admission and HbA1c (hazard ratio: 1.680, 1.493; p value < 0.001, 0.008, respectively). Decreasing glucose variability during admission for surgery is important for patients with type 2 DM to decreasing re-admission rates and LOS. HBA1c may also identify patients at higher risk of postoperative complications and possibility of re-admission.

Association Between Levels of Pre-operative Glycosylated Hemoglobin and Post-operative Surgical Site Infections After Elective Surgery in a Low-Income Country

“…However, it is worth mentioning that we also came across a few studies that either showed mixed results or did not find any conclusive relationship between HbA1c and SSI [11]. In a 2019 study, the probability of developing surgical complications or readmission with respect to gender, age, or presence of hypertension was found to be nonsignificant [9]. Furthermore, no association between the type of wound and HbA1c levels was found in our study.…”

“…A study done by Kopp Lugli et al found an overall 4.1 times increased risk of developing SSI [4]. Raised HbA1c preoperatively is linked with an increased risk of infection, length of hospital stay and readmission in 30 days [9]. However, it is worth mentioning that we also came across a few studies that either showed mixed results or did not find any conclusive relationship between HbA1c and SSI [11].…”

“…Prevention of surgical site infections is important since it plays a significant role in hospital readmissions, prolonged stays, and greater financial burden [7]. After doing thorough literature research, we came to the conclusion that many studies support the association between elevated HbA1c levels with increased risk for SSI [8][9][10]. This aligns with the findings of our study where patients with HbA1c levels greater than 6.5% were more likely to develop SSI as compared to those who had lower levels (p-value: 0.01).…”

“…Fluctuation in glucose levels causes an increased production of free radicals which generates increased oxidative stress. In a study, it was established that acute and chronic fluctuations in blood glucose levels corresponded with elevated oxidative stress markers namely: urine 8-isoprostaglandin F2α, serum thiobarbituric acid-reactive substance, and serum 8hydroxydeoxyguanosine [9,12]. In addition, variation in glucose levels also induced a rise in serum level of the chronic inflammatory marker (c-reactive protein), absence of antioxidants, and a greater incidence of microvascular complications [12][13][14][15].…”

Effects of intravenous and inhalation anesthesia on blood glucose and complications in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

“…Decreasing glucose variability during admission for surgery is essential for patients with type 2 diabetes to reducing re-admission rates and length of stay. Glycated hemoglobin (HBA1c) may also identify patients at higher risk of postoperative complications and the possibility of re-admission (8). Regular preoperative inpatient blood glucose monitoring and management can improve intraoperative and postoperative glycemic control and reduce the incidence of hypoglycemia.…”