Doubova Svetlana V, Ferreira-Hermosillo Aldo, Pérez-Cuevas Ricardo, Barsoe Casper, Gryzbowski-Gainza Erick, Valencia Juan E
Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, 06720, Mexico City, Mexico.
Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades del CMN siglo XXI, Mexico City, Mexico.
BMC Health Serv Res. 2018 Aug 3;18(1):602. doi: 10.1186/s12913-018-3412-3.
To describe the demographic and clinical characteristics of Type 1 diabetes (T1D) patients affiliated with the Mexican Institute of Social Security (IMSS) and ascertain the socio-demographic and clinical risk factors associated with emergency room (ER) visits and diabetes-related hospitalizations.
We conducted secondary data analysis of a cross-sectional study. The study included T1D patients 18 years of age and older who in 2016 attended follow-up visits at the endocrinology department of two IMSS tertiary care hospitals in Mexico City. The study variables included demographics, acute and chronic complications, and healthcare services utilization. Multiple Poisson and negative binomial regressions served to determine the association between the study covariates and the dependent variables: ER visits and diabetes-related hospitalizations.
The study included 192 patients, of which 29.2% were men; average age was 32.3 years, with only 13.6% controlled (glycosylated hemoglobin (HbA1C) < 7%); the mean HbA1C was 9.2, and 64.6% presented chronic complications. During 2016, 39.0% visited ER services, and 33.9% were hospitalized. The common risk factors for ER visits and hospitalization were older age at the beginning of diabetes, severe acute complications, chronic microvascular and macrovascular complications, and other comorbidities. Female sex, high school education, depression, and repeated visits to the endocrinologist were associated with ER visits, whereas active smoking and the interaction between diabetes duration > 10 years and HbA1c > 9.0% were additional risk factors for hospitalization.
The poor clinical conditions of T1D patients contribute to explain the escalating demand for health services for diabetes patients at the IMSS. The identification of risk factors enables focalizing interventions to improve the health outcomes of T1D patients and reduce the proportion of ER visits and hospital admissions.
描述墨西哥社会保障局（IMSS）附属的1型糖尿病（T1D）患者的人口统计学和临床特征，并确定与急诊室（ER）就诊和糖尿病相关住院治疗相关的社会人口统计学和临床风险因素。
我们对一项横断面研究进行了二次数据分析。该研究纳入了2016年在墨西哥城两家IMSS三级护理医院内分泌科进行随访的18岁及以上的T1D患者。研究变量包括人口统计学、急性和慢性并发症以及医疗服务利用情况。多元泊松回归和负二项回归用于确定研究协变量与因变量（ER就诊和糖尿病相关住院治疗）之间的关联。
该研究纳入了192名患者，其中29.2%为男性；平均年龄为32.3岁，只有13.6%的患者病情得到控制（糖化血红蛋白（HbA1C） < 7%）；平均HbA1C为9.2，64.6%的患者出现慢性并发症。2016年期间，39.0%的患者前往急诊室就诊，33.9%的患者住院治疗。急诊就诊和住院的常见风险因素包括糖尿病发病初期年龄较大、严重急性并发症、慢性微血管和大血管并发症以及其他合并症。女性、高中教育程度、抑郁症以及反复就诊内分泌科与急诊就诊相关，而主动吸烟以及糖尿病病程>10年与HbA1c>9.0%之间的相互作用是住院的额外风险因素。
T1D患者较差的临床状况有助于解释IMSS糖尿病患者对医疗服务需求的不断增加。识别风险因素有助于集中干预措施，以改善T1D患者的健康结局，并减少急诊就诊和住院的比例。
