Does Hyperglycemia at Discharge Predict Return Visits by Type 2 Diabetics?

Summary and Comment |
July 12, 2016

Does Hyperglycemia at Discharge Predict Return Visits by Type 2 Diabetics?

  1. Daniel J. Pallin, MD, MPH

There was no linear relationship between discharge glucose levels and 7-day outcomes.

  1. Daniel J. Pallin, MD, MPH

Investigators at a single U.S. emergency department (ED) performed a chart review to determine whether there was a relationship between glucose level at ED discharge and 7-day outcomes.

Included were 566 ED encounters with 422 unique patients. Main outcomes were occurrence of diabetic ketoacidosis or hyperosmolar hyperglycemic state, repeat ED visit for hyperglycemia, or hospitalization for any reason within 7 days of the index ED visit. Generalized estimating equation modeling was performed to seek evidence of a linear relationship between ED discharge glucose level and outcomes. None was found.

Comment

There is no evidence that one glucose threshold is better than another as a criterion for discharge of hyperglycemic type 2 diabetics seen in the ED. “How high is too high?” may not have an answer — or the answer might be that it's not an important question to ask. This study sought, and failed to find, a linear relationship. The possibility of a more-complex nonlinear relationship was not excluded. Nevertheless, the study's conclusions are consistent with common sense and current practice: Well-appearing type 2 diabetics without evidence of diabetic ketoacidosis or hyperosmolar hyperglycemic state can be discharged with substantial hyperglycemia and face little risk of bad outcomes in the ensuing week. Probably the most important recommendation is to remain vigilant for underlying causes of hyperglycemia, such as infection or another stressor.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH–National Center for Advancing Translational Sciences Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee, 2015–2016; Chair, Program Committee, 2017–2018)

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Reader Comments (1)

CYNTHIA OWENS

This is an issue that insurance reviewers in hospital settings should be informed of. It would avoid unnecessary physician sanctions.

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