Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA.
Endocr Pract. 2010 Nov-Dec;16(6):945-51. doi: 10.4158/EP10093.OR.
To determine the relationship between inpatient glycemic control and hospital readmission in patients with congestive heart failure (CHF).
We used an electronic data collection tool to identify patients with a discharge diagnosis of CHF who underwent point-of-care glucose assessments. Timeweighted mean glucose (TWMG), hemoglobin A1c, and glycemic lability index (GLI) served as glycemic indicators, and readmission for CHF was determined at 30 days and between 30 and 90 days.
The analysis included 748 patients. After adjustment for significant covariates, log-transformed increasing TWMG (odds ratio 3.3; P = .03) and log-transformed hemoglobin A1c (odds ratio 5.5; P = .04) were independently associated with higher readmission for CHF between 30 and 90 days, but not by 30 days. Renal disease, African American race, and year of hospital admission were also significantly associated with readmission, but GLI was not. There was no significant difference in TWMG when analyzed on the basis of race or renal status. We noted a decrease in TWMG (P = .004) and a trend for reduction in readmission rates between 30 and 90 days (P = .06) after hospital-wide interventions were implemented to improve glycemic control, but no significant difference was detected in GLI or hypoglycemia.
Increasing glucose exposure, but not glycemic variability, was associated with higher risk of readmission between 30 and 90 days in patients with CHF. Prospective studies are needed to confirm or refute these results.
确定充血性心力衰竭（CHF）患者住院血糖控制与再入院之间的关系。
我们使用电子数据采集工具来确定接受即时血糖评估的 CHF 出院诊断患者。时间加权平均血糖（TWMG）、糖化血红蛋白（HbA1c）和血糖变异性指数（GLI）作为血糖指标，30 天和 30-90 天内再次因 CHF 入院。
分析纳入了 748 例患者。在校正了显著协变量后，对数转换的 TWMG 增加（优势比 3.3；P =.03）和对数转换的 HbA1c 增加（优势比 5.5；P =.04）与 30-90 天内再次因 CHF 入院独立相关，但与 30 天内无关。肾脏疾病、非裔美国人种族和入院年份也与再入院显著相关，但 GLI 则不然。基于种族或肾脏状况分析时，TWMG 没有显著差异。我们注意到，在实施了改善血糖控制的全院干预措施后，TWMG 降低（P =.004），30-90 天内再入院率呈下降趋势（P =.06），但 GLI 或低血糖没有显著差异。
在 CHF 患者中，血糖暴露增加而非血糖变异性增加与 30-90 天内再入院风险增加相关。需要前瞻性研究来证实或反驳这些结果。
