Top

BMC Endocrine Disorders

Published in:

Open Access 01-12-2021 | Insulins | Research

Magnitude and predictors of hospital admission, readmission, and length of stay among patients with type 2 diabetes at public hospitals of Eastern Ethiopia: a retrospective cohort study

Authors: Lemma Demissie Regassa, Assefa Tola

Published in: BMC Endocrine Disorders | Issue 1/2021

Abstract

Background

Type 2 Diabetes (T2D) represents one of the leading causes for hospital admissions and outpatient visits. Hence, T2D continuously imposes a significant burden to healthcare systems. The aim of this study was to assess predictors of hospital admission, readmission rates, and length of hospital stay among T2D patients in government hospitals of Eastern Ethiopia from 2013 to 2017.

Methods

This study utilized retrospective data from a cohort of T2D patients following their treatment in government hospitals in Harari regional state of Ethiopia. Predictor of hospital admission was determined using parametric survival analysis methods. The readmission rate and length of hospital stay were determined by Poisson regression and mixed effect Poisson regression, respectively. All association were performed at 95% confidence level. Significance of association with determinants was reported using the hazard rate for hospital admission, and the incidence rate for readmission and length of hospital stay. Optimal model for each outcome was selected by using information criteria after fitness was checked.

Results

The hospital admission rate for T2D patients was 9.85 (95%CI: 8.32, 11.66) per 1000-person-year observation. Alcohol drinking, inactive lifestyle, being a rural resident, history of comorbidities, and experiencing chronic diabetes complications were predictors of hospital admission. Seventy-one (52.2%) of the admitted patients had a history of readmission. Readmission rate was increased by being female, duration of disease, inactive lifestyle, having BMI greater than 29.9 kg/m², and higher blood glucose. The median time of hospital stay for admitted patients was 18 (IQR:7). The length of hospital stay was longer among females, patients with the history of insulin administration, and higher blood glucose.

Conclusion

Multiple and complex factors were contributing for high diabetes admission and readmission rates as well as for longer in-hospital duration among T2D patients in Harari regional state. Socio-demographic characteristics (sex, place of residence), behavioral factors (alcohol intake, lifestyle), and medical conditions (longer duration of disease, comorbidities, chronic diabetes complications, higher blood glucose level, and treatment modality) were significant determinants of hospital admission, readmission and longer hospital stay among T2D patients.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1(Suppl 1):S62-9. https://doi.org/10.2337/dc10-S062. Erratum in: Diabetes Care. 2010;33(4):e57.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13-S27. https://doi.org/10.2337/dc18-S002.

Khalid J, Raluy-Callado M, Curtis B, Boye K, Maguire A, Reaney M. Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the Uk general practice research database linked to English hospital episode statistics. Int J Clin Pract. 2014;68(1):40–8.PubMedCrossRef

World Health Organization. Global Report on Diabetes. Geneva: World Health Organization; 2016.

Fraze T, Jiang H, Burgess J. Quality. Hospital stays for patients with diabetes, 2008. Agency Health Care Res. 2010;93:1–11.

Comino EJ, Harris MF, Islam MF, Tran DT, Jalaludin B, Jorm L, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res. 2015;15(1):12.PubMedCrossRefPubMedCentral

Faiza H. Reasons for admission of individual with diabetes to the Tripoli medical center in 2015. Diabetes Metab Syndr. 2019;13(4):2571–8.PubMedCrossRef

Johnston P. National Diabetes Inpatient Audit: how can inpatient teams make patients feel safer? Br J Nurs. 2018;27(10):534–6.PubMedCrossRef

Sajjad MA, Holloway KL, de Abreu LL, Mohebbi M, Kotowicz MA, Pedler D, et al. Comparison of incidence, rate and length of all-cause hospital admissions between adults with Normoglycaemia, impaired fasting glucose and diabetes: a retrospective cohort study in Geelong. Australia BMJ open. 2018;8(3):e020346.PubMedCrossRef

10.

Tomlin AM, Tilyard MW, Dovey SM, Dawson AG. Hospital admissions in diabetic and non-diabetic patients: a case-control study. Diabetes Res Clin Pract. 2006;73(3):260–7.PubMedCrossRef

11.

Akbar DH, Al-Gamdi AA. Common causes of admission in diabetics. Saudi Med J. 2000;21(6):539–42.PubMed

12.

Ajayi EA, Ajayi AO. Pattern and outcome of diabetic admissions at a federal medical center: a 5-year review. Ann Afr Med. 2009;8(4):271–5. https://doi.org/10.4103/1596-3519.59584.

13.

Allan B, Sampson M. Admissions Avoidance and Diabetes: Guidance for Clinical Commissioning Groups and Clinical Teams; 2013.

14.

Begum N, Donald M, Ozolins IZ, Dower J. Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes. Diabetes Res Clin Pract. 2011;93(2):260–7.PubMedCrossRef

15.

Kefale AT, Eshetie TC, Gudina EK. Hospitalization pattern and treatment outcome among diabetic patients admitted to a teaching Hospital in Ethiopia: a prospective observational study. J Health Med Nurs. 2016;28:34–41.

16.

Unadike B, Essien I, Akpan N, Peters E, Essien O. Profile and outcome of diabetic admissions at the University of Uyo Teaching Hospital, Uyo. Int J Med Med Sci. 2013;5(6):286–9.

17.

Maradzika J, Mzorodzi T, Chikwasha V. Factors associated with hospital admissions among registered diabetes mellitus patients in Guruve and Mazowe District-Mashonaland Central Province, 2013. Int J Health Promot Educ. 2017;55(2):57–65.CrossRef

18.

Tomlin AM, Dovey SM, Tilyard MW. Risk factors for hospitalization due to diabetes complications. Diabetes Res Clin Pract. 2008;80(2):244–52.PubMedCrossRef

19.

Ncube-Zulu T, Danckwerts M. Comparative hospitalization cost and length of stay between patients with and without diabetes in a large tertiary Hospital in Johannesburg, South Africa. Int J Diabetes Dev Countries. 2014;34(3):156–62.CrossRef

20.

Cheng S-W, Wang C-Y, Ko Y. Costs and Length of Stay of Hospitalizations Due to Diabetes-Related Complications. J Diab Res. 2019;2019:1–5. https://doi.org/10.1155/2019/2363292.

21.

Wu J. Sample size calculation for the one-sample log-rank test. Pharm Stat. 2015;14(1):26–33.PubMedCrossRef

22.

Hsieh FY, Lavori PW. Sample-size calculations for the cox proportional hazards regression model with nonbinary covariates. Control Clin Trials. 2000;21(6):552–60.PubMedCrossRef

23.

Freedman LS. Tables of the number of patients required in clinical trials using the Logrank test. Stat Med. 1982;1(2):121–9.PubMedCrossRef

24.

Ostling S, Wyckoff J, Ciarkowski SL, Pai C-W, Choe HM, Bahl V, et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol. 2017;3(1):3.PubMedCrossRefPubMedCentral

25.

Couchoud C, Pozet N, Labeeuw M, Pouteil-Noble C. Screening early renal failure: cut-off values for serum Creatinine as an Indicator of renal impairment. Kidney Int. 1999;55(5):1878–84.PubMedCrossRef

26.

Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/.

27.

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. https://doi.org/10.1016/S0140-6736(03)15268-3. Erratum in: Lancet. 2004;363(9412):902.

28.

American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes. 2019;37(1):11–34. https://doi.org/10.2337/cd18-0105.

29.

Lotfy M, Adeghate J, Kalasz H, Singh J, Adeghate E. Chronic complications of diabetes mellitus: a mini review. Curr Diabetes Rev. 2017;13(1):3–10.PubMedCrossRef

30.

Faselis C, Katsimardou A, Imprialos K, Deligkaris P, Kallistratos M, Dimitriadis K. Microvascular complications of type 2 diabetes mellitus. Curr Vasc Pharmacol. 2020;18(2):117–24.PubMedCrossRef

31.

Girach A, Vignati L. Diabetic microvascular complications--can the presence of one predict the development of another? J Diabetes Complicat. 2006;20(4):228–37.CrossRef

32.

Viigimaa M, Sachinidis A, Toumpourleka M, Koutsampasopoulos K, Alliksoo S, Titma T. Macrovascular complications of type 2 diabetes mellitus. Curr Vasc Pharmacol. 2020;18(2):110–6.PubMedCrossRef

33.

Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum? Indian J Endocrinol Metab. 2016;20(4):546–51.PubMedCrossRefPubMedCentral

34.

Hu G, Jousilahti P, Barengo NC, Qiao Q, Lakka TA, Tuomilehto J. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care. 2005;28(4):799–805.PubMedCrossRef

35.

Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143–211.PubMedPubMedCentralCrossRef

36.

Kim S, Boye KS. Excessive hospitalizations and its associated economic burden among people with diabetes in the United States. Value Health. 2009;12(2):267–72.PubMedCrossRef

37.

Rosenthal MJ, Fajardo M, Gilmore S, Morley JE, Naliboff BD. Hospitalization and mortality of diabetes in older adults. A 3-year prospective study. Diabetes Care. 1998;21(2):231–5.PubMedCrossRef

38.

Bateganya MH, Luie JR, Nambuya AP, Otim MA. Morbidity and mortality among diabetic patients admitted to Mulago hospital, Uganda. Malawi Med J. 2003;15(3):91–4.PubMedPubMedCentral

39.

Ojobi JE, Dunga J, Ogiator MO, Mbaave P, RNB. Indications and Outcome of Admission of Diabetic Patients into the Medical Wards in a Nigerian Tertiary Hospital-Atwo Year Review. Jos J Med. 2017;11(2):53–8.

40.

Mainous AG 3rd, King DE, Garr DR, Pearson WS. Race, rural residence, and control of diabetes and hypertension. Ann Fam Med. 2004;2(6):563–8.PubMedCrossRefPubMedCentral

41.

Smith MW, Owens PL, Andrews RM, Steiner CA, Coffey RM, Skinner HG, et al. Differences in severity at admission for heart failure between rural and urban patients: the value of adding laboratory results to administrative data. BMC Health Serv Res. 2016;16(1):133.PubMedCrossRefPubMedCentral

42.

Stumetz KS, Yi-Frazier JP, Mitrovich C, Briggs EK. Quality of Care in Rural Youth with Type 1 Diabetes: A Cross-Sectional Pilot Assessment. BMJ Open Diabetes Res Care. 2016;4(1):e000300.PubMedCrossRefPubMedCentral

43.

Dąbrowski M, Grondecka A. Diabetes as a risk factor of hospitalization in the surgical Ward due to Cancer in the elderly and middle-aged population. Arch Med Sci. 2017;13(5):1025–30.PubMedCrossRef

44.

Burke V, Zhao Y, Lee A, Hunter E, Spargo R, Gracey M, et al. Predictors of type 2 diabetes and diabetes-related hospitalisation in an Australian Aboriginal cohort. Diabetes Res Clin Pract. 2007;78:360–8.PubMedCrossRef

45.

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–67.PubMedCrossRefPubMedCentral

46.

Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Jama. 2001;286(10):1218–27.PubMedCrossRef

47.

Thomas DE, Elliott EJ, Naughton GA. Exercise for Type 2 Diabetes Mellitus. Cochrane Database Syst Rev. 2006;(3):Cd002968.

48.

Ahmed AT, Karter AJ, Liu J. Alcohol consumption is inversely associated with adherence to diabetes self-care Behaviours. Diabet Med. 2006;23(7):795–802.PubMedCrossRefPubMedCentral

49.

Emanuele NV, Swade TF, Emanuele MA. Consequences of alcohol use in diabetics. Alcohol Health Res World. 1998;22(3):211–9.PubMedPubMedCentral

50.

Ekoru K, Doumatey A, Bentley AR, Chen G, Zhou J, Shriner D, et al. Type 2 diabetes complications and comorbidity in sub-Saharan Africans. EClinicalMedicine. 2019;16:30–41.PubMedCrossRefPubMedCentral

51.

Ahern MM, Hendryx M. Avoidable hospitalizations for diabetes: comorbidity risks. Dis Manag. 2007;10(6):347–55.PubMedCrossRef

52.

Rubin DJ. Correction to: hospital readmission of patients with diabetes. Curr Diab Rep. 2018;18(4):21.PubMedCrossRef

53.

Guk M, Choi J. Factors associated with hospitalization among patients with diabetes mellitus. Korean J Adult Nurs. 2017;29:1–11.CrossRef

54.

Jelinek HF, Osman WM, Khandoker AH, Khalaf K, Lee S, Almahmeed W, et al. Clinical Profiles, Comorbidities and Complications of Type 2 Diabetes Mellitus in Patients from United Arab Emirates. BMJ Open Diabetes Res Care. 2017;5(1):e000427.PubMedCrossRefPubMedCentral

55.

Chen H, Zhang Y, Wu D, Gong C, Pan Q, Dong X, et al. Comorbidity in adult patients hospitalized with type 2 diabetes in Northeast China: an analysis of hospital discharge data from 2002 to 2013. Biomed Res Int. 2016;2016:1671965.PubMedPubMedCentralCrossRef

56.

Moss SE, Klein R, Klein BE. Risk factors for hospitalization in people with diabetes. Arch Intern Med. 1999;159(17):2053–7.PubMedCrossRef

57.

Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia. 2014;57(12):2465–74.PubMedCrossRef

58.

Likitmaskul S, Wacharasindhu S, Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, et al. Thailand diabetes registry project: type of diabetes, glycemic control and prevalence of microvascular complications in children and adolescents with diabetes. J Med Assoc Thail. 2006;89(Suppl 1):S10–6.

59.

Gedebjerg A, Almdal TP, Berencsi K, Rungby J, Nielsen JS, Witte DR, et al. Prevalence of micro- and macrovascular diabetes complications at time of type 2 diabetes diagnosis and associated clinical characteristics: a cross-sectional baseline study of 6958 patients in the Danish Dd2 cohort. J Diabetes Complicat. 2018;32(1):34–40.CrossRef

60.

Lo SK, Li IT, Tsou TS, See L. Non-significant in Univariate but significant in multivariate analysis: a discussion with examples. Changgeng Yi Xue Za Zhi. 1995;18(2):95–101.PubMed

61.

Shrestha A, Kosalram K, Gopichandran V. Gender difference in Care of Type 2 diabetes. J Nepal Med Assoc. 2013;52:245–50.CrossRef

62.

McGill JB, Vlajnic A, Knutsen PG, Recklein C, Rimler M, Fisher SJ. Effect of gender on treatment outcomes in type 2 diabetes mellitus. Diabetes research and clinical practice. 2013;102(3):167–74.

63.

Kim S, Boye KS. Obesity and incremental hospital charges among patients with and without diabetes in the United States. Value Health. 2009;12(5):723–9.PubMedCrossRef

64.

Sonmez A, Yumuk V, Haymana C, Demirci I, Barcin C, Kıyıcı S, et al. Impact of obesity on the metabolic control of type 2 diabetes: results of the Turkish Nationwide survey of glycemic and other metabolic parameters of patients with diabetes mellitus (Temd obesity study). Obes Facts. 2019;12(2):167–78.PubMedCrossRefPubMedCentral

65.

Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.PubMedCrossRef

66.

Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408–14.PubMedCrossRef

67.

Ahmann A. Reduction of hospital costs and length of stay by good control of blood glucose levels. Endocr Pract. 2004;10(Suppl 2):53–6.PubMedCrossRef

68.

Bhatia V, Wilding GE, Dhindsa G, Bhatia R, Garg RK, Bonner AJ, et al. Association of Poor Glycemic Control with prolonged hospital stay in patients with diabetes admitted with exacerbation of congestive heart failure. Endocr Pract. 2004;10(6):467–71.PubMedCrossRef

69.

Evans NR, Dhatariya KK. Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality. Clin Med (Lond). 2012;12(2):137–9.CrossRef

70.

Garg R, Bhutani H, Alyea E, Pendergrass M. Hyperglycemia and length of stay in patients hospitalized for bone marrow transplantation. Diabetes Care. 2007;30(4):993.PubMedCrossRef

71.

Gebreegziabher Y, McCullough PA, Bubb C, Loney-Hutchinson L, Makaryus JN, Anand N, et al. Admission hyperglycemia and length of hospital stay in patients with diabetes and heart failure: a prospective cohort study. Congest Heart Fail. 2008;14(3):117–20.PubMedCrossRef

72.

Soh JGS, Wong WP, Mukhopadhyay A, Quek SC, Tai BC. Predictors of 30-Day Unplanned Hospital Readmission among Adult Patients with Diabetes Mellitus: A Systematic Review with Meta-Analysis. BMJ Open Diabetes Res Care. 2020;8(1):e001227.PubMedCrossRefPubMedCentral

73.

Zapatero A, Gómez-Huelgas R, González N, Canora J, Asenjo A, Hinojosa J, et al. Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards. Endocr Pract. 2014;20(9):870–5.PubMedCrossRef

74.

Bach QN, Gilmore RA, Sheffield MC, Hawkins WA. Evaluation of insulin use and hypoglycemia in hospitalized elderly patients. Hosp Pharm. 2017;52(11):761–5.PubMedCrossRefPubMedCentral

75.

Tosi F, Muggeo M, Brun E, Spiazzi G, Perobelli L, Zanolin ME, et al. Combination treatment with metformin and Glibenclamide versus single-drug therapies in type 2 diabetes mellitus: a randomized, double-blind, comparative study. Metab Clin Exp. 2003;52:862–7.PubMedCrossRef

76.

Nachum Z, Zafran N, Salim R, Hissin N, Hasanein J, Gam Ze Letova Y, et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study. Diabetes Care. 2017;40(3):332.PubMedCrossRef

77.

Regassa LD, Gete YK, Mekonnen FA. Time to acute kidney injury and its predictors among newly diagnosed type 2 diabetic patients at government hospitals in Harari region, East Ethiopia. PLoS One. 2019;14(5):e0215967.PubMedCrossRefPubMedCentral

Title: Magnitude and predictors of hospital admission, readmission, and length of stay among patients with type 2 diabetes at public hospitals of Eastern Ethiopia: a retrospective cohort study
Authors: Lemma Demissie Regassa
Assefa Tola
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Insulins
Insulins
Type 2 Diabetes
Published in: BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI: https://doi.org/10.1186/s12902-021-00744-3

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Magnitude and predictors of hospital admission, readmission, and length of stay among patients with type 2 diabetes at public hospitals of Eastern Ethiopia: a retrospective cohort study

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Deterioration of diabetic nephropathy via stimulating secretion of cytokines by atrial natriuretic peptide

Up-regulation of sex-determining region Y-box 9 (SOX9) in growth hormone-secreting pituitary adenomas

“Slipped capital femoral epiphysis in a 25-year-old hypogonadic man with a large cranial chondroma: causality or coincidence? “

Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

Associations between CD160 polymorphisms and autoimmune thyroid disease: a case-control study

Documented diabetes care among older people receiving home care services: a cross‐sectional study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page