Yan Justin W, Gushulak Katherine M, Columbus Melanie P, van Aarsen Kristine, Hamelin Alexandra L, Wells George A, Stiell Ian G
The Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Int J Emerg Med. 2017 Dec;10(1):23. doi: 10.1186/s12245-017-0150-y. Epub 2017 Jul 12.
Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation.
We conducted a 1-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days.
There were 833 ED visits for hyperglycemia in the 1-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age <25 years (OR 2.6, 95% CI 1.5-4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit.
This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.
糖尿病控制不佳的患者可能会因高血糖发作（包括糖尿病酮症酸中毒和高渗高血糖状态）的管理和治疗而反复前往急诊科（ED）。本研究的目的是确定在初次就诊后30天内预测糖尿病患者因高血糖而计划外再次前往急诊科就诊的危险因素。
我们对4家三级医疗急诊科中出院诊断为高血糖、糖尿病酮症酸中毒或高渗高血糖状态的18岁及以上患者进行了为期1年的健康记录回顾。训练有素的研究人员收集了患者特征数据，并确定患者在初次就诊后30天内是否因高血糖而计划外再次前往急诊科就诊。使用广义估计方程的多变量逻辑回归模型来考虑多次就诊的患者，确定与30天内因高血糖而再次前往急诊科就诊独立相关的预测变量。
在这1年期间，有833次因高血糖前往急诊科就诊。其中54.6%为男性，平均（标准差）年龄为48.8（19.5）岁。在所有就诊者中，156人（18.7%）在30天内因高血糖再次前往急诊科就诊。与高血糖再次就诊独立相关的因素包括过去一个月内曾因高血糖就诊（比值比[OR] 3.5，95%置信区间[CI] 2.1 - 5.8）、年龄<25岁（OR 2.6，95% CI 1.5 - 4.7）、血糖>20 mmol/L（OR 2.2，95% CI 1.3 - 3.7）、有家庭医生（OR 2.2，95% CI 1.0 - 4.6）以及正在使用胰岛素（OR 1.9，95% CI 1.1 - 3.1）。收缩压在90 - 150 mmHg之间（OR 0.53，95% CI 0.30 - 0.93）和心率>110次/分钟（OR 0.41，95% CI 0.23 - 0.72）是与未再次因高血糖就诊独立相关的保护因素。
这项基于急诊科的独特研究报告了与糖尿病患者30天内因高血糖而再次前往急诊科就诊相关的5个危险因素和2个保护因素。临床医生在对出现高血糖的糖尿病患者进行管理、预后评估和处置决策时应考虑这些危险因素。
