Factors Associated With Hospitalization for Hypoglycemia and Hyperglycemia Among Older People in Long-Term Care Facilities

Background: Individuals with diabetes newly entering long-term care facilities (LTCFs) encounter changes in care needs and facility and care process-related factors, which potentially impact diabetes treatment outcomes. This study examined the 12-month incidence of hospitalizations for hypoglycemia and hyperglycemia in residents with diabetes and factors associated with these hospitalizations following LTCF entry. 

Methods: This retrospective cohort study included residents aged ≥ 65 years with diabetes who entered a LTCF between 2015 and 2018 using data from the Registry of Senior Australians. Cumulative incidence of hospitalization for hypoglycemia or hyperglycemia in the 12 months following entry was evaluated. Factors associated with hypoglycemia or hyperglycemia hospitalizations were examined using a Fine–Gray model, accounting for the competing event of mortality. Subdistribution hazard ratios (sHRs) were reported. 

Results: Of the 55,734 individuals included (median age 84 years), 1.0% (95% confidence interval [CI]: 0.9–1.1) were hospitalized for hypoglycemia, and 0.5% (95% CI: 0.4–0.6) for hyperglycemia in the 12 months after LTCF entry. Factors associated with a higher rate of hospitalization for hypoglycemia included high (sHR: 2.59, 95% CI: 1.61–4.17) or medium (sHR: 2.61, 95% CI: 1.61–4.24) level of care needs, renal disease (sHR: 1.22, 95% CI: 1.01–1.49), prior hospitalization with hypoglycemia (sHR: 2.18, 95% CI: 1.77–2.67) or hyperglycemia (sHR: 1.61, 95% CI: 1.19–2.18), use of insulin (sHR: 6.15, 95% CI: 4.99–7.59), sulfonylureas (sHR: 1.41, 95% CI: 1.14–1.74), or angiotensin-converting enzyme inhibitors (sHR: 1.23, 95% CI: 1.02–1.47). Factors associated with a higher rate of hospitalization for hyperglycemia included preferred spoken language other than English (sHR: 1.40, 95% CI: 1.02–1.93), dementia (sHR: 1.39, 95% CI: 1.08–1.80), prior hospitalization with hyperglycemia (sHR: 3.88, 95% CI: 2.72–5.53) or hypoglycemia (sHR: 2.50, 95% CI: 1.83–3.41), use of insulin (sHR: 2.01, 95% CI: 1.51–2.69), or metformin (sHR: 1.42, 95% CI: 1.10–1.84). 

Conclusions: The risk of hospitalization for hypoglycemia or hyperglycemia may be reduced through diabetes care planning at LTCF entry informed by the identified risk factors for these complications.