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The increased risk for cognitive impairment postdischarge in patients with T2D can be mitigated via the provision of tailored postdischarge care.
The intersection of diabetes management and cognitive impairment (CI) is a crucial yet underexplored area for patients with T2D, explains Hua Shao, MD, PhD. “Despite the widespread prevalence of CI at hospital postdischarge, there is an evidence gap in understanding the unmet healthcare needs of this population,” he says. “Recognizing this, our research further focuses on evaluating whether tailored care can help mitigate patients’ vulnerability associated with cognitive issues.”
For a study published in Diabetes Care, Dr. Shao and colleagues investigated the specific healthcare needs of a subpopulation of patients with diabetes: those admitted due to diabetic ketoacidosis (DKA) or severe hypoglycemia (SH). “We expected that these patients might have received less optimal care before, particularly if they also suffered from CI,” Dr. Shao says. “We considered two hypotheses: first, patients who had CI had higher readmission risk, and second, this elevated risk can be mitigated by providing postdischarge care.”
Increased Risk for CI Can Be Mitigated Via Tailored Postdischarge Care
To evaluate these hypotheses, the study team conducted a detailed analysis of patient outcomes following hospital discharge using the National Readmission Database. They followed patients with and without CI for 30 days after the original discharge date and compared their risk for readmission. The study team identified 23,775 patients initially admitted for SH and 140,490 for DKA. To assess the mitigating role, the researchers used PDC as an interaction term in the model to determine the heterogeneity impact of CI on readmission risk between those who did and did not receive PDC. (Figure)
“Our study’s findings are salient for physicians, especially endocrinologists, as they underscore the heightened risk for hospital readmission among patients with diabetes and CI,” Dr. Shao notes. “We discovered that this increased risk can be mitigated through the provision of tailored PDC. This insight is vital for clinical practice, as it reinforces the importance of ensuring continuous and appropriate PDC for this vulnerable group. For endocrinologists, who often manage complex diabetes cases, our study provides concrete evidence supporting the need for comprehensive care plans that extend beyond hospital stays. This approach can significantly improve patient outcomes and reduce the likelihood of readmission.”
Collaboration Among Clinicians Who Treat Patients With TDC Is Critical
To effectively integrate their findings, clinicians can focus on providing appropriate PDC through a multidisciplinary approach, according to the study team. “This involves collaboration among primary care providers, endocrinologists, neurologists, and geriatric specialists to ensure comprehensive and tailored care for patients with diabetes and CI,” Dr. Shao observes. “Such coordinated efforts are key to reducing readmissions and improving overall patient outcomes.”
Dr. Shao and colleagues concur that it would be pertinent to have randomized controlled trials to further ascertain their findings: whether appropriate PDC could mitigate the readmission risk or improve the outcomes of patients originally admitted to the hospital due to hypoglycemia or ketoacidosis. Additionally, they would like to see these findings expanded to other populations with diabetes.
“We believe this study promotes more attention for patients with diabetes and [CI] and advocate for enhanced continuity of care to optimize these patients’ outcomes,” added Yehua Wang, MSPH, lead author of the study.
“Individuals with diabetes and cognitive function decline may face substantial challenges in self-management after discharging from hospitals,” Dr. Shao concludes. “Our study contributes valuable evidence that can guide the development of personalized therapeutic strategies, and it underscores the critical need for enhanced PDC.”
