Department of Endocrinology and Diabetes, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas. 2024 Feb;36(1):101-109. doi: 10.1111/1742-6723.14320. Epub 2023 Oct 2.
Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018.
Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. 'Non-preventable' presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence.
Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001).
Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth.
尽管儿科糖尿病管理方面取得了重大治疗进展，但仍存在因糖尿病酮症酸中毒（DKA）等潜在可预防（PP）并发症而导致的急诊科就诊的重大问题。我们旨在研究 2008 年至 2018 年期间 0-19 岁青少年因糖尿病相关的急诊科就诊情况以及随后的住院情况，分析其特点、发生率和趋势。
数据来自维多利亚州紧急情况最低数据集和国家糖尿病登记处。使用国际疾病分类和相关健康问题第十次修订版澳大利亚修正版的诊断代码来定义与糖尿病相关的急诊科就诊情况。“不可预防”就诊是指新诊断出糖尿病的青少年人数，其余则归类为可预防的糖尿病相关就诊情况。使用泊松回归模型来研究发病率和患病率的趋势。
8220 例就诊病例中，有 4872 例（59%）为可预防病例，4683 例（57%）为 DKA，6200 例（82%）需要住院治疗。2008 年至 2018 年间，糖尿病相关的急诊科就诊率从每年每 100 名糖尿病患者 38.4 次降至 27.5 次（β= -0.04；置信区间 [CI] -0.04 至 -0.03；P < 0.001）。女性、0-4 岁的儿童和农村地区的青少年比男性、年龄较大的群体和大都市地区的青少年的就诊率更高。2008-2009 年，每 100 名糖尿病患者的 DKA 就诊人数为 20.1 次，而 2017-2018 年则降至 14.9 次。与大都市地区相比，农村地区的 DKA 就诊率高 68%（发病率比 1.68；CI 1.59-1.78；P < 0.001）。
尽管糖尿病相关的急诊科就诊率有所下降，但可预防的糖尿病相关就诊和随后的住院治疗仍然很高。需要进行患者层面的研究，以了解农村青少年中 DKA 就诊率增加的原因。
