AT THE ADA ANNUAL SCIENTIFIC SESSIONS

BOSTON (FRONTLINE MEDICAL NEWS)Poor glucose control was associated with longer length of stay and higher costs among hospitalized adults in a large community health system.

Of 9,995 patients who were admitted to any of five Scripps Health hospitals in San Diego County between 2012 and 2013 and who underwent point-of-care blood glucose monitoring regardless of diabetes diagnosis, 1,236 (12%) had blood glucose values greater than 400 mg/dL (poor glucose control), and 8,759 (88%) had blood glucose values between 70 and 199 mg/dL (good glucose control). After controlling for age and gender, those with poor glucose control had a significantly longer mean length of stay than did those with good control (mean of 8.5 vs. 5.74 days), Laura Talavera of Scripps Whittier Diabetes Institute, San Diego, reported at the annual scientific sessions of the American Diabetes Association.

A unit-specific analysis showed that mean length of stay also was significantly longer among those with poor glucose control in critical care units, Ms. Talavera said.

Additionally, those with poor control who had the longest lengths of stay had no diabetes diagnosis code; additional research is needed to determine whether those were patients with diabetes that was not coded or if they were in fact patients without diabetes, she said.

Not surprisingly, given the strong correlation between length of stay and hospital costs, those with poor glucose control also had significantly higher total variable costs, compared with those with good control (mean of $16,382 vs. $13,896).

Patients included in the study were aged 18-104 years (mean of 66 years), and 52% were men. The hospitals had an ethnically diverse patient mix, which varied by location, yet the findings were similar at each hospital, Ms. Talavera said, adding that each hospital had a clinical team including an advanced-practice nurse and a diabetes educator, and standard glucose management protocols were in place.

“We certainly did have other patients that might have been in the 200-300 [mg/dL] range, which we recognize is also poor control, but we really wanted to focus in on those in the most severe hyperglycemic range,” she said, noting that those at the other end of the spectrum of poor control – patients with hypoglycemia – were not included in this analysis as the number of patients with hypoglycemia and severe hypoglycemia was fairly low, and the investigators “wanted to focus in on what was a particular challenge for us.”

The findings have implications for the care of many hospitalized patients; a recent public health report from the University of California, Los Angeles, noted that one of every three hospital admissions in California involves a diagnosis of diabetes mellitus. As hospitals comprise the largest proportion of total health care expenditures (43%) related to diabetes care, the current findings – particularly the finding that 12% of subjects had at least one blood glucose value greater than 400 mg/dL – suggest that putting systems of care in place to rapidly identify and improve glucose control might lead to shorter lengths of stay and lower cost, she concluded.

Ms. Talavera reported having no conflicts of interest to disclose.

sworcester@frontlinemedcom.com

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