Zisman-Ilani Yaara, Fasing Kevin, Weiner Mark, Rubin Daniel J
Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.
University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.
BMJ Open Diabetes Res Care. 2020 Oct;8(1). doi: 10.1136/bmjdrc-2020-001771.
Patients with diabetes are at greater risk of hospital readmission than patients without diabetes. There is a need to identify more modifiable risk factors for readmission as potential targets for intervention. Cardiorespiratory fitness is a predictor of morbidity and mortality. The purpose of this study was to examine whether there is an association between exercise capacity based on the maximal workload achieved during treadmill stress testing and readmission among patients with diabetes.
This retrospective cohort study included adult patients with diabetes discharged from an academic medical center between July 1, 2012 and December 31, 2018 who had a stress test documented before the index discharge. Univariate analysis and multinomial multivariable logistic regressions were used to evaluate associations with readmission within 30 days, 6 months, and 1 year of discharge. Exercise capacity was measured as metabolic equivalents (METs).
A total of 580 patients with 1598 hospitalizations were analyzed. Mean METs of readmitted patients were significantly lower than for non-readmitted patients (5.7 (2.6) vs 6.7 (2.6), p<0.001). After adjustment for confounders, a low METs level (<5) was associated with higher odds of readmission within 30 days (OR 5.46 (2.22-13.45), p<0.001), 6 months (OR 2.78 (1.36-5.65), p=0.005), and 1 year (OR 2.16 (1.12-4.16), p=0.022) compared with medium (5-7) and high (>7) METs level. During the 6.5-year study period, patients with low METs had a mean of 3.2±3.6 hospitalizations, while those with high METs had 2.5±2.4 hospitalizations (p=0.007).
Lower exercise capacity is associated with a higher risk of readmission within 30 days, 6 months, and 1 year, as well as a greater incidence of hospitalization, in patients with diabetes. Future studies are needed to explore whether exercise reduces readmission risk in this population.
糖尿病患者比非糖尿病患者再次入院的风险更高。有必要确定更多可改变的再入院风险因素，作为潜在的干预目标。心肺适能是发病率和死亡率的一个预测指标。本研究的目的是探讨基于跑步机压力测试中达到的最大工作量的运动能力与糖尿病患者再入院之间是否存在关联。
这项回顾性队列研究纳入了2012年7月1日至2018年12月31日期间从一所学术医疗中心出院的成年糖尿病患者，这些患者在首次出院前有压力测试记录。采用单因素分析和多项多变量逻辑回归来评估与出院后30天、6个月和1年内再入院的关联。运动能力以代谢当量（METs）来衡量。
共分析了580例患者的1598次住院情况。再入院患者的平均METs显著低于未再入院患者（5.7（2.6）对6.7（2.6），p<0.001）。在对混杂因素进行调整后，与中等（5-7）和高（>7）METs水平相比，低METs水平（<5）与30天内再入院几率较高相关（比值比5.46（2.22-13.45），p<0.001）、6个月内（比值比2.78（1.36-5.65），p=0.005）和1年内（比值比2.16（1.12-4.16），p=0.022）。在6.5年的研究期间，低METs患者平均住院3.2±3.6次，而高METs患者平均住院2.5±2.4次（p=0.007）。
在糖尿病患者中，较低的运动能力与30天、6个月和1年内再入院的较高风险以及更高的住院发生率相关。未来需要开展研究来探索运动是否能降低该人群的再入院风险。
