Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada.
CJEM. 2024 Jun;26(6):424-430. doi: 10.1007/s43678-024-00686-4. Epub 2024 Apr 18.
This study's aims were to describe the outcomes of patients with diabetes presenting with their first ED visit for hyperglycemia, and to identify predictors of recurrent ED visits for hyperglycemia.
Using linked databases, we conducted a population-based cohort study of adult and pediatric patients with types 1 and 2 diabetes presenting with a first ED visit for hyperglycemia from April 2010 to March 2020 in Ontario, Canada. We determined the proportion of patients with a recurrent ED visit for hyperglycemia within 30 days of the index visit. Using multivariable regression analysis, we examined clinical and socioeconomic predictors for recurrent visits.
There were 779,632 patients with a first ED visit for hyperglycemia. Mean (SD) age was 64.3 (15.2) years; 47.7% were female. 11.0% had a recurrent visit for hyperglycemia within 30 days. Statistically significant predictors of a recurrent visit included: male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, more family physician or internist visits within the past year, being rostered to a family physician, previous ED visits in the past year, ED or hospitalization within the previous 14 days, access to homecare services, and previous hyperglycemia encounters in the past 5 years. Alcoholism and depression or anxiety were positive predictors for the 18-65 age group.
This population-level study identifies predictors of recurrent ED visits for hyperglycemia, including male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, higher previous healthcare system utilization (ED visits and hospitalization) for hyperglycemia, being rostered to a family physician, and access to homecare services. Knowledge of these predictors may be used to develop targeted interventions to improve patient outcomes and reduce healthcare system costs.
本研究旨在描述首次因高血糖就诊于急诊科的糖尿病患者的结局，并确定高血糖再次就诊的预测因素。
本研究通过使用关联数据库，对 2010 年 4 月至 2020 年 3 月期间在加拿大安大略省因首次高血糖就诊急诊科的 1 型和 2 型糖尿病的成年和儿科患者进行了一项基于人群的队列研究。我们确定了在就诊后 30 天内再次因高血糖就诊急诊科的患者比例。通过多变量回归分析，我们检查了再次就诊的临床和社会经济预测因素。
共有 779632 例患者因首次高血糖就诊急诊科。患者的平均（标准差）年龄为 64.3（15.2）岁，47.7%为女性。11.0%的患者在 30 天内再次因高血糖就诊急诊科。再次就诊的统计学显著预测因素包括：男性、1 型糖尿病、少数民族较少和教育或就业水平较低的地区、较高的糖化血红蛋白水平、过去 1 年家庭医生或内科医生就诊次数较多、由家庭医生负责、过去 1 年内有过急诊就诊或住院史、家庭保健服务可及性以及过去 5 年内有过高血糖就诊史。酗酒和抑郁或焦虑是 18-65 岁年龄组的阳性预测因素。
这项基于人群的研究确定了高血糖再次就诊的预测因素，包括男性、1 型糖尿病、少数民族较少和教育或就业水平较低的地区、糖化血红蛋白水平较高、过去因高血糖就诊于急诊科和住院的医疗保健系统利用率较高、由家庭医生负责以及家庭保健服务可及性。了解这些预测因素可能有助于制定有针对性的干预措施，以改善患者结局并降低医疗保健系统成本。
