Predictors of Prolonged Hospitalization in Non-Critically Ill Patients with Type 2 Diabetes Mellitus

Presentation Number: SAT 628
Date of Presentation: April 1st, 2017

Tay Yu Kwang Donovan1, Trier TSUI NAM Lau*2, THAN Sein2 and Tan HUI CHENG2
1SingHealth, Singapore, Singapore, 2Sengkang Health, Singapore, Singapore

Abstract

Background

Occurrence of hypoglycemia in the inpatient setting in patients with Type 2 Diabetes Mellitus (T2DM) is common with an estimated prevalence of about 12 to 18%.1 Inpatient hypoglycemia is associated with a higher mortality and increased length of stay (LOS).2We sought to identify risk factors associated with increased LOS in multi ethnic cohort with T2DM.

Methods

Data for this pilot retrospective cohort study were obtained from electronic databases of patients who are non-critically ill with T2DM admitted between 1 January to 31 May 2016 to Sengkang General Hospital (n=168). Charlson Comorbidity Index (CCI) excluding diabetes was used to control for severity of illness. Hypoglycemia was defined as a capillary blood glucose level of less than 4mmol/L obtained using point of care Accu-chek® Inform II system (Roche Diagnostics). Predictors of prolonged hospitalization were assessed using Mann Whitney or Kruskal Wallis test as appropriate for categorical variables and Pearson correlation for continuous variables. Multivariate analysis was done using stepwise multiple linear regression with LOS log transformed. Univariate analyses between hypoglycemia and non-hypoglycemia group was also performed.

Results

The cohort consisted of predominantly Chinese participants (66.7%) while Malay, Indians and Eurasian made up 8.9%, 21.4% and 3.0% respectively. Gender distribution was similar with 59.5% males and 40.5% females. Mean age was 69.3 ± 13.7 years, mean CCI score 1.6 ± 1.8 and the median LOS was 10 days (4-25). The prevalence of hypoglycemia in the cohort was 17.9%. Presence of hypoglycemia, ethnicity, age, CCI, BMI, Hba1c, eGFR were associated with LOS. Median LOS was significantly longer in the hypoglycemic group (20 days; 8-31) vs non-hypoglycemic controls (9 days; 3-23) (p<0.01). Median LOS was 13(6-27) in Chinese, 9(3-33) in Malays and 6(2-13) in Indians and 5(5-9) in Eurasians (p=0.034). Age and CCI were positively correlated to LOS (r=0.275, p<0.01) and (r=0.309, p<0.01) respectively. Hba1c, BMI and eGFR were negatively correlated (r=-0.204, p<0.01), (r=-0.214, p=0.012), (r=-0.181, p=0.02) respectively. CCI and Hba1c, BMI and eGFR were not significantly different between hypoglycemia and non-hypoglycemic groups. The use of insulin and/or sulfonylurea did not influence the LOS although insulin/sulfonylurea users were significantly higher in the hypoglycemic group (76.7%) than controls (55.1%) (p= 0.029). On stepwise multiple linear regression, age, occurrence of hypoglycemia and CCI score remained as strong predictors of the LOS.

Conclusions

Hypoglycemia remained independently associated with prolonged hospitalization irrespectively of age and severity of illness in patients with T2DM.

 

Nothing to Disclose: TYKD, TTNL, TS, THC