Journal of General Internal Medicine

, Volume 32, Issue 10, pp 1097–1105 | Cite as

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

  • Rozalina G. McCoy
  • Kasia J. Lipska
  • Jeph Herrin
  • Molly M. Jeffery
  • Harlan M. Krumholz
  • Nilay D. Shah
Original Research



Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management.


To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia.


Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S.


Adults ≥18 years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N = 342,186).

Main Measures

Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes.

Key Results

We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2 years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization.


Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.


diabetes epidemiology readmissions hospital medicine hypoglycemia hyperglycemia health services research risk assessment 


Author Contributions

McCoy and Shah had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: McCoy, Shah. Acquisition of data: Herrin, Jeffrey, Shah. Interpretation of data: McCoy, Lipska, Herrin, Shah. Drafting of the manuscript: McCoy. Critical revision of the manuscript for important intellectual content: McCoy, Lipska, Herrin, Krumholz, Jeffrey, Shah. Statistical analysis: Herrin. Obtaining funding: Shah. Administrative, technical, and material support: N/A. Study supervision: Shah.

Compliance with Ethical Standards


This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Dr. Shah was funded in part through project number R18HS18339 from the Agency for Healthcare Research and Quality (AHRQ). Dr. McCoy receives support from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr. Lipska receives support from the National Institute on Aging and the American Federation of Aging Research through the Paul Beeson Career Development Award (K23AG048359) and the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). She also receives support from CMS to develop and maintain publicly reported quality measures.

Prior Presentations

Parts of this work were previously presented as poster presentations at the American Diabetes Association 75th Scientific Sessions in Boston, MA (June 7, 2015), and the AcademyHealth Annual Research Meeting in Minneapolis, MN (June 15, 2015).

Conflict of Interest

Dr. Krumholz is a recipient of research agreements from Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; is the recipient of a grant from Medtronic and the Food and Drug Administration, through Yale, to develop methods for post-market surveillance of medical devices; works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures; chairs a cardiac scientific advisory board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science, the Physician Advisory Board for Aetna, and the Open Trials Advisory Board for the Laura and John Arnold Foundation; and is the founder of Hugo, a personal health information platform. All remaining authors declare that they do not have a conflict of interest.

Supplementary material

11606_2017_4095_MOESM1_ESM.docx (64 kb)
ESM 1 (DOCX 63 kb)


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Rozalina G. McCoy
    • 1
    • 2
    • 3
  • Kasia J. Lipska
    • 4
  • Jeph Herrin
    • 5
    • 6
  • Molly M. Jeffery
    • 2
    • 3
  • Harlan M. Krumholz
    • 5
    • 7
    • 8
    • 9
  • Nilay D. Shah
    • 2
    • 3
    • 10
  1. 1.Division of Primary Care Internal Medicine, Department of MedicineMayo ClinicRochesterUSA
  2. 2.Division of Health Care Policy & Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA
  3. 3.Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryRochesterUSA
  4. 4.Section of Endocrinology, Department of Internal MedicineYale School of MedicineNew HavenUSA
  5. 5.Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenUSA
  6. 6.Health Research and Educational TrustChicagoUSA
  7. 7.Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal MedicineYale School of MedicineNew HavenUSA
  8. 8.Center for Outcomes Research and EvaluationYale New Haven HealthNew HavenUSA
  9. 9.Department of Health Policy and ManagementYale School of Public HealthNew HavenUSA
  10. 10.OptumLabsCambridgeUSA

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