National Institute of Health, Rome, Italy.
PLoS One. 2013 May 23;8(5):e63675. doi: 10.1371/journal.pone.0063675. Print 2013.
We investigated temporal trends and geographic variations in both hospitalizations and in-hospital mortality rates for acute diabetic complications (ADC) in the Italian universal health care system.
A retrospective review of the medical records of patients with either primary or secondary discharge diagnosis of hyperglycaemic acute complications (ICD-9-CM codes 250.1, 250.2, 250.3) or hypoglycemic coma (ICD-9-CM code 251.0) was performed in period 2001-2010. Standardized rates by age and gender on 2001 Italian population and by diabetic population were calculated. We identified 7,601.883 diabetes-related hospital discharges. Out of them, 266,374 (3.5%) were due to ADC, either ketoacidosis/hyperosmolarity (94.4%) or hypoglycemic coma (5.6%). The rate of discharge for ADC decreased by 51.1% from 2001 to 2010 (14.4 vs. 7.1 discharge rate/1,000 diabetic people; 5.7% decrease per year, test for trend, p<0.001) with a similar trend for both hyperglycemic and hypoglycemic complications. Diabetic people in the younger age groups (≤ 19 and 20-44 years old) had a significantly greater rate of discharge for ADC than people aged 65 years and over (≤ 19 10-fold increase; 20-44: 2-fold increase). In-hospital mortality rate was 7.6%, with 211 preventable deaths in younger diabetic people (≤ 44 years old). There was a large variability among Italian Regions and the ratio between the highest and the lowest regional discharge rate reached 300% in 2010.
Decreasing temporal trend in hospitalizations for preventable ADC suggests improving outpatient care. In younger diabetic patients, however, both hospitalization rates and in-hospital mortality are still a matter of concern.
我们研究了意大利全民医疗保健系统中急性糖尿病并发症（ADC）的住院率和住院死亡率的时间趋势和地域差异。
我们对 2001 年至 2010 年期间因高血糖急性并发症（ICD-9-CM 代码 250.1、250.2、250.3）或低血糖昏迷（ICD-9-CM 代码 251.0）而接受初次或再次出院诊断的患者的病历进行了回顾性审查。按年龄和性别对 2001 年意大利人口和糖尿病患者进行了标准化率计算。我们共发现 7601883 例与糖尿病相关的住院出院记录。其中，266374 例（3.5%）是 ADC 导致的，包括酮症酸中毒/高渗性昏迷（94.4%）或低血糖昏迷（5.6%）。2001 年至 2010 年，ADC 的出院率下降了 51.1%（14.4 与 7.1 出院率/每 1000 名糖尿病患者；每年下降 5.7%，趋势检验，p<0.001），高血糖和低血糖并发症均呈类似趋势。≤19 岁和 20-44 岁的年轻糖尿病患者的 ADC 出院率明显高于 65 岁及以上的患者（≤19 岁者增加 10 倍；20-44 岁者增加 2 倍）。住院死亡率为 7.6%，其中 211 例年轻糖尿病患者（≤44 岁）的死亡可预防。意大利各地区之间的差异很大，2010 年最高和最低地区出院率之间的比值达到 300%。
可预防 ADC 的住院率呈下降趋势，表明门诊护理有所改善。然而，在年轻的糖尿病患者中，住院率和住院死亡率仍然令人担忧。
