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Yan JW, Vujcic B, Le BN, Van Aarsen K, Chen T, Halane F, Clemens KK. Predictors of 30-day recurrent emergency department visits for hyperglycemia in patients with types 1 and 2 diabetes: a population-based cohort study. CAN J EMERG MED 2024; 26:424-430. [PMID: 38635005 DOI: 10.1007/s43678-024-00686-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Justin W Yan
- 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.
| | - Branka Vujcic
- Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Britney N Le
- ICES Western, London Health Sciences Research Institute, London, ON, Canada
| | - Kristine Van Aarsen
- Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Tom Chen
- Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Fardowsa Halane
- Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Kristin K Clemens
- ICES Western, London Health Sciences Research Institute, London, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Liao WT, Lee CC, Kuo CL, Lin KC. Predicting readmission due to severe hyperglycemia after a hyperglycemic crisis episode. Diabetes Res Clin Pract 2022; 192:110115. [PMID: 36220515 DOI: 10.1016/j.diabres.2022.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/20/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
AIM This study aimed to investigate the readmission pattern and risk factors for patients who experienced a hyperglycemic crisis. METHODS Patients admitted to MacKay Memorial Hospital for diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) between January 2016 and April 2019 were studied. The timing of the first readmission for hyperglycemia and other causes was recorded. Kaplan-Meier analysis was used to compare patients with hyperglycemia and all-cause readmissions. Cox regression was used to identify independent predictors for hyperglycemia and all-cause readmission post-discharge. RESULTS The study cohort included 410 patients, and 15.3 % and 46.3 % of them had hyperglycemia and all-cause readmissions, respectively. The DKA and HHS group showed a similar incidence for hyperglycemia, with the latter group showing a higher incidence of all-cause readmissions. The significant predictors of hyperglycemia readmissions included young age, smoking, hypoglycemia, higher effective osmolality, and hyperthyroidism in the DKA group and higher glycated hemoglobin level in the HHS group. CONCLUSIONS Patients who experienced DKA and HHS had similar hyperglycemia readmission rates; however, predictors in the DKA group were not applicable to the HHS group. Designing different strategies for different types of hyperglycemic crisis is necessary for preventing readmission.
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Affiliation(s)
- Wei-Tsen Liao
- Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC; Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC
| | - Chun-Chuan Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC
| | - Chih-Lin Kuo
- Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Yong Cheng Rehabilitation Clinic, Taipei City 10663, Taiwan, ROC
| | - Kuan-Chia Lin
- Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Cheng Hsin General Hospital, Taipei, Taiwan, ROC.
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Gorelik Y, Bloch-Isenberg N, Hashoul S, Heyman SN, Khamaisi M. Hyperglycemia on Admission Predicts Acute Kidney Failure and Renal Functional Recovery among Inpatients. J Clin Med 2021; 11:jcm11010054. [PMID: 35011805 PMCID: PMC8745405 DOI: 10.3390/jcm11010054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hyperglycemia is associated with adverse outcomes in hospitalized patients. We aimed to assess the impact of glucose levels upon admission on the subsequent deterioration or improvement of kidney function in inpatients with a focus on diabetes or reduced baseline kidney function as possible modifiers of this effect. METHODS Running a retrospective cohort analysis, we compared patients with normal vs. high glucose levels upon admission. We applied multivariable logistic regression models to study the association between baseline glucose levels with subsequent renal and clinical outcomes. Interaction terms were used to study a possible modifier effect of diabetes. RESULTS Among 95,556 inpatients (52% males, mean age 61 years), 15,675 (16.5%) had plasma glucose higher than 180 mg/dL, and 72% of them were diabetics. Patients with higher glucose at presentation were older, with a higher proportion of co-morbid conditions. Rates of acute kidney injury (AKI), acute kidney functional recovery (AKR), and mortality were proportional to reduced renal function. AKI, AKR, and mortality were almost doubled in patients with high baseline glucose upon admission. Multivariable analysis with interaction terms demonstrated an increasing adjusted probability of all events as glucose increased, yet this association was observed principally in non-diabetic patients. CONCLUSIONS Hyperglycemia is associated with AKI, AKR, and mortality in non-diabetic inpatients in proportion to the severity of their acute illness. This association diminishes in diabetic patients, suggesting a possible impact of treatable and easily reversible renal derangement in this population.
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Affiliation(s)
- Yuri Gorelik
- Department of Medicine D, Rambam Health Care Campus, Haifa 3109601, Israel; (Y.G.); (N.B.-I.); (M.K.)
- Department of Medicine A, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa 3109601, Israel;
| | - Natalie Bloch-Isenberg
- Department of Medicine D, Rambam Health Care Campus, Haifa 3109601, Israel; (Y.G.); (N.B.-I.); (M.K.)
- Department of Medicine A, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa 3109601, Israel;
| | - Siwar Hashoul
- Department of Medicine A, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa 3109601, Israel;
- Department of Medicine A, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Samuel N. Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem 91240, Israel
- Correspondence:
| | - Mogher Khamaisi
- Department of Medicine D, Rambam Health Care Campus, Haifa 3109601, Israel; (Y.G.); (N.B.-I.); (M.K.)
- Department of Medicine A, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa 3109601, Israel;
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Wei Y, Wu C, Su F, Zhang H, Zhang J, Zheng R. Clinical characteristics and outcomes of patients with diabetic ketoacidosis of different severity. Medicine (Baltimore) 2020; 99:e22838. [PMID: 33157926 PMCID: PMC7647520 DOI: 10.1097/md.0000000000022838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze the influencing factors and outcomes of the different severity of diabetic ketoacidosis (DKA).A total of 50 children with DKA admitted to the Department of Pediatrics, Tianjin Medical University General Hospital from January 2009 to December 2018 were included in this study. The patients were divided into mild group, moderate group, and severe group according to the severity of the disease. We then analyzed the clinical characteristics and outcomes of the 3 groups.Compared to mild and moderate DKA groups, patients with severe DKA were more likely to present chest tightness, and higher levels of blood osmotic pressure, urea, and creatinine (P < .05). Logistic regression analysis showed that blood osmotic pressure, creatinine, and chest tightness were independent factors for severity of DKA. There was a significant difference in the resolution time of DKA among the 3 groups (mild vs moderate: 9.0 hours vs 15.25 hours; moderate vs severe: 15.25 hours vs 24.5 hours, P < .001). There were statistical differences in the decline of Glasgow score among 3 groups (P = .004).Patients with severe DKA showed higher osmotic pressure and creatinine, as well as dyspnea. The children with severe DKA were more likely to present progression of neurological symptoms, which was necessary to pay attention to the presence of brain edema.
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Iturbide-Casas MA, Cámara-Martos F, Molina-Luque R, Molina-Recio G. Survival Analysis of Enterally Fed Patients: Prognosis and Mortality Risk According to Baseline Characteristics. JPEN J Parenter Enteral Nutr 2019; 44:1057-1065. [PMID: 31736137 DOI: 10.1002/jpen.1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/09/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Enteral nutrition is widely used. However, its benefits remain unclear in specific conditions like dementia. This study assesses the survival of enterally fed patients and the baseline characteristics associated with higher mortality. METHODS A retrospective analysis of biochemical and clinical data from 377 patients (age 77.5 ± 13.8) who received enteral tube feeding (ETF) at a tertiary hospital in Spain was performed. Kaplan-Meier and Cox regressions were used to analyze survival expectancy and mortality risk (MR). Risk was evaluated for 30/180 days and up to 5 years. RESULTS The most common individual diagnoses leading to ETF prescription were dementia (37.9%) and head/neck/upper-gastrointestinal-tract cancer (17.5%). Comorbidities (high blood pressure [HBP] and/or diabetes) were present in 72.4% of patients. The first 30 days after tube placement showed the highest mortality rate, corresponding to 85.4% of patients that did not continue being tube-fed. Multivariate Cox analysis (P < .05, 95% CI) showed HBP and glycemia to be predictive of overall (hazard ratio [HR] = 1.600; HR = 1.756) and long-term (HR = 3.092; HR = 4.539) death. In the short-term, only glycemia showed an increased MR (HR = 1.572). CONCLUSION This enterally fed population showed a noticeably high initial mortality rate. Despite official recommendations against it, ETF is very common in advanced dementia. Baseline characteristics are useful for identifying patients that would be less benefited by the intervention. Accordingly, families should be informed about realistic outcomes and risks derived from this procedure.
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Affiliation(s)
| | - Fernando Cámara-Martos
- Departamento de Bromatología y Tecnología de los Alimentos, Universidad de Córdoba, Córdoba, Spain
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