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Melson E, Fazil M, Lwin H, Thomas A, Yeo TF, Thottungal K, Tun H, Aftab F, Davitadze M, Gallagher A, Seidu S, Higgins K. Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes. Clin Med (Lond) 2024; 24:100029. [PMID: 38387535 DOI: 10.1016/j.clinme.2024.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes. METHODS A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022. Data on demographics, comorbidities and background glucose-lowering medications were collected. RESULTS Six-hundred-and-sixty-five people with diabetes and moderate/severe frailty were included in our analysis. For people with no HbA1c in the last six months preceding admission, only 9.0% had it assessed during inpatient. Deintensification rates were 19.1%. Factors that were associated with adverse inpatient outcomes included inpatient hypoglycaemia, non-White ethnicity, and being overtreated (HbA1c <7.0% [53 mmol/mol] with any glucose-lowering medication). CONCLUSION The assessment and deintensification rate in secondary care for people with diabetes and frailty is low. Inpatient hypoglycaemia, non-White ethnicity, and overtreatment are important factors in determining inpatient outcomes highlighting the importance of deintensification and the need for an evidence-based risk stratification tool.
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Affiliation(s)
- Eka Melson
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom; Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom.
| | - Mohamed Fazil
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Hnin Lwin
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Anu Thomas
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Ting Fong Yeo
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Kevin Thottungal
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - HayMar Tun
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Faseeha Aftab
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Meri Davitadze
- Clinic NeoLab, Tbilisi, Georgia; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alison Gallagher
- Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
| | - Samuel Seidu
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom
| | - Kath Higgins
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom; Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
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Malabu UH, Adegboye O, Hayes OG, Ryan A, Vangaveti VN, Jhamb S, Robertson K, Sangla KS. Influence of Ethnicity on Outcomes of Diabetes Inpatient Hypoglycemia: an Australian Perspective. J Endocr Soc 2020; 4:bvaa009. [PMID: 32104749 PMCID: PMC7039405 DOI: 10.1210/jendso/bvaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
Abstract
Aims
To evaluate outcomes of diabetic inpatient hypoglycemia among Aboriginal and Torres Strait Islander (ATSI) compared with Australian Caucasian patients.
Methods
A retrospective audit of diabetic patients aged > 18 years admitted at a regional hospital general ward between April 1, 2015, and March 31, 2016, was analyzed. The database contains clinical information at the time of admission and initial discharge and readmission within 4 weeks thereafter.
Results
A total of 1618 (of 6027) patients were admitted with diabetes representing 23.7% of the total ward admissions, of which 484 (29.9%) had inpatient hypoglycemia. Of the 91 patients with available data analyzed, ATSI origin with inpatient hypoglycemia was associated with longer length of stay (LOS) (hazard ratio [HR], 2.1, 95% confidence interval [CI], 1.2-3.5), whereas severe hypoglycemia (≤ 2.2 mmol/L) in both ATSI and non-ATSI was significantly associated with longer LOS (HR, 2.3; 95% CI, 1.2-4.2). No significant differences in LOS were found for gender, age, and Carlson comorbidity index (CCI). The adjusted model for likelihood of readmission, gender, indigenous status, and CCI were not significant risk factors for readmission to the hospital. Readmitted patients were older (50-59 years vs < 50 years, P = 0.001; 60-69 years vs < 50 years, P = 0.032; 70+ years vs < 50 years, P = 0.031).
Conclusion
We reported high rate of inpatient hypoglycemia in our study population. Indigenous Australian diabetic patients with inpatient hypoglycemia had significantly longer LOS compared with non-Indigenous Caucasian counterparts. Further prospective studies on a larger population are needed to confirm our findings.
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Affiliation(s)
- Usman H Malabu
- The Townsville Hospital, Douglas, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - Oyelola Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | | | | | - Venkat N Vangaveti
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | - Shaurya Jhamb
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | | | - Kunwarjit S Sangla
- The Townsville Hospital, Douglas, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
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