| Abstract |
Abstract
Patients with diabetes often experience extreme glucose values during their hospitalization. It is unknown whether these episodes of hypoglycemia or hyperglycemia, especially during the last days of a hospitalization, may affect the short-term clinical course of patients who experience them. The goal of the current Ph.D. proposal is to evaluate whether hypoglycemia and increased glucose variability (GV) on the last day of hospitalization are associated with increased 30-day readmissions and mortality at 30, 90, and 180 days following a hospital discharge.
We collected nationwide data, which were extracted from electronic databases focusing on hospitalized patients with diabetes admitted in Veteran Affairs hospitals in the USA. The study procedures, i.e., data collection, statistical analyses, and manuscript preparations, were partially conducted at the University of Maryland and the Baltimore VA Medical Center. Study protocols were approved by the University of Maryland Institutional Review Board (IRB) and the Baltimore Veterans Affairs Research and Development Committee.
The results of our studies are unique and innovative. In the first study, we demonstrated that hypoglycemia and low glucose values at hospital discharge are associated with increased risk for a 30-day readmission and 30-, 90-, and 180-day post-discharge mortality. Additionally, we expanded our research questions and identified specific cutoff low glucose values, below which patients with diabetes are at higher risk of readmission and post-discharge mortality.
In the second study, we evaluated the role of GV on the last day of hospitalization. We used the coefficient of variation (CV) and standard deviation (SD) to represent the two most common metrics of glucose variability. We identified that patients with diabetes and a high CV or SD on the last day of hospitalization were more likely to be readmitted 30 days after discharge. Overall, the findings of this proposal were published in the Journal of Clinical Endocrinology and Metabolism and at BMJ Open Diabetes Research & Care and received international recognition, as follows: https://www.ncbi.nlm.nih.gov/pubmed/31042288
https://pubmed.ncbi.nlm.nih.gov/32398351/
https://www.medscape.com/viewarticle/912731
https://endocrinenews.endocrine.org/patients-with-diabetes-are-40-percent-more-likely-to-be-readmitted-to-the-hospital/
Following the completion of the above retrospective- epidemiological studies, which showed the importance of inpatient glycemic control, we focused on clinical trials and interventions that can lead to improving glycemic control during hospitalization. Our group developed a strong interest in utilizing technologies and mainly Continuous Glucose Monitoring (CGM) devices in innovative ways to improve care for patients with DM in the inpatient setting. Our thought was that by using CGM devices, we could decrease hypoglycemia in the hospital setting. Although CGM devices are approved for use in the ambulatory setting, the use of these devices in the hospital setting is considered investigational. We described a novel monitoring system, which we named Glucose Telemetry, which overcomes many of the CGM limitations, as it is able to provide remote glucose management. We have evaluated the above system in several single and multicenter randomized clinical trials, evaluating its ability to improve glycemic outcomes and whether this intervention can be feasible in the hospital setting.
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