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Mehta PB, Kohn MA, Rov-Ikpah E, San Luis C, Johnson C, Lee G, Koliwad S, Rushakoff RJ. Novel Automated Self-adjusting Subcutaneous Insulin Algorithm Improves Glycemic Control and Physician Efficiency in Hospitalized Patients. J Diabetes Sci Technol 2024; 18:541-548. [PMID: 38454631 PMCID: PMC11089873 DOI: 10.1177/19322968241232673] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND Hyperglycemia occurs in 22% to 46% of hospitalized patients, negatively affecting patient outcomes, including mortality, inpatient complications, length of stay, and hospital costs. Achieving inpatient glycemic control is challenging due to inconsistent caloric intake, changes from home medications, a catabolic state in the setting of acute illness, consequences of acute inflammation, intercurrent infection, and limitations in labor-intensive glucose monitoring and insulin administration. METHOD We conducted a retrospective cross-sectional analysis at the University of California San Francisco hospitals between September 3, 2020 and September 2, 2021, comparing point-of-care glucose measurements in patients on nil per os (NPO), continuous total parenteral nutrition, or continuous tube feeding assigned to our novel automated self-adjusting subcutaneous insulin algorithm (SQIA) or conventional, physician-driven insulin dosing. We also evaluated physician efficiency by tracking the number of insulin orders placed or modified. RESULTS The proportion of glucose in range (70-180 mg/dL) was higher in the SQIA group than in the conventional group (71.0% vs 69.0%, P = .153). The SQIA led to a lower proportion of severe hyperglycemia (>250 mg/dL; 5.8% vs 7.2%, P = .017), hypoglycemia (54-69 mg/dL; 0.8% vs 1.2%, P = .029), and severe hypoglycemia (<54 mg/dL; 0.3% vs 0.5%, P = .076) events. The number of orders a physician had to place while a patient was on the SQIA was reduced by a factor of more than 12, when compared with while a patient was on conventional insulin dosing. CONCLUSIONS The SQIA reduced severe hyperglycemia, hypoglycemia, and severe hypoglycemia compared with conventional insulin dosing. It also improved physician efficiency by reducing the number of order modifications a physician had to place.
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Affiliation(s)
- Paras B Mehta
- Division of Endocrinology and Metabolism, University of California, San Francisco, CA, USA
| | - Michael A Kohn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Esther Rov-Ikpah
- Institute of Nursing Excellence, University of California, San Francisco, CA, USA
| | - Craig San Luis
- Department of Clinical Systems, University of California, San Francisco, CA, USA
| | - Craig Johnson
- Department of Health Informatics, University of California, San Francisco, CA, USA
| | - Gwendolyn Lee
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Suneil Koliwad
- Division of Endocrinology and Metabolism, University of California, San Francisco, CA, USA
| | - Robert J Rushakoff
- Division of Endocrinology and Metabolism, University of California, San Francisco, CA, USA
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2
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Feleke BE, Sacre J, Tomic D, Huynh Q, Shaw JE, Magliano DJ. Hospital admissions among people with diabetes: A systematic review. Diabet Med 2024; 41:e15236. [PMID: 37811704 DOI: 10.1111/dme.15236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To describe the reasons for hospital admission among people with diabetes. METHODS We searched Emcare, Embase, Medline and Google Scholar databases for population-based studies describing the causes of hospitalisation among people with diabetes. We included articles published in English from 1980 to 2022. For each study, we determined the most frequent reasons for admission. Studies were assessed for quality using the Newcastle Ottawa quality assessment tool. RESULTS 6920 research articles were retrieved from the search of all sources. After screening the titles and abstracts of these, we reviewed the full text of 135 papers and finally included data from 42 studies. Admissions among the total diabetes were reported in 25 papers: 5 articles reported type 1 diabetes alone, 10 articles reported type 2 diabetes alone and the remaining 2 articles reported type 1 and type 2 diabetes separately. Among the 25 total and type 2 diabetes studies that reported the distribution of hospitalisations in broad categories, cardiovascular diseases (CVD) were the leading cause of admission in 19/25 (76%) of studies. Among the 19 studies that reported CVD admissions by subcategories, ischaemic or coronary heart disease was the leading subtype of CVD in 58% of studies. The other common causes of admissions were infections, renal disorders, endocrine, nutritional, metabolic and immunity disorders. In people with type 1 diabetes, acute diabetes complications were the leading cause of admission. CONCLUSION CVD are the leading cause of hospital admission for people with diabetes, with ischaemic or coronary heart disease as the predominant subtype.
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Affiliation(s)
- Berhanu Elfu Feleke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Julian Sacre
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dunya Tomic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jonathan E Shaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
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3
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Wiley K, Blackburn J, Mendonca E, Menachemi N, De Groot M, Vest JR. Associations between Outpatient Laboratory Test Age and Healthcare Utilization in Type 2 Diabetes Care. J Diabetes Metab Disord 2023; 22:1319-1326. [PMID: 37975086 PMCID: PMC10638224 DOI: 10.1007/s40200-023-01250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/07/2023] [Indexed: 11/19/2023]
Abstract
Purpose To examine the longitudinal relationship between the age or shelf-life of common type 2 diabetes laboratory tests for serum creatinine, cholesterol, and glycated hemoglobin A1c conducted in outpatient settings and subsequent inpatient hospitalizations and emergency department visits. Methods This study analyzes panel data from two healthcare delivery systems' electronic health records (EHR) for patients aged 18 years and older managing type 2 diabetes. We used EHR data to quantify the age of three laboratory tests: serum creatinine, cholesterol, and glycated hemoglobin A1c. Encounter data were used to determine the frequency of inpatient hospitalizations and emergency department visits. Negative binomial regressions with fixed effects were performed to compute marginal effects, levels of statistical significance, and 95% confidence intervals. Results The average age for serum creatinine laboratory tests was 1.51 months (95%CI: 1.49-1.53). We computed older average ages for hemoglobin A1c (mean:6.17 months; 95%CI: 6.11-6.23) and serum creatinine tests (mean: 8.73; 95%CI: 8.65-8.81). Older laboratory tests were associated with an increase in the total expected counts of subsequent inpatient hospitalizations (ME = 0.047; p < 0.001) and ED visits (ME = 0.034; p < 0.001). Conclusion Findings from this study indicate that older type 2 diabetes laboratory tests are associated with increases in the total expected count of subsequent inpatient hospitalizations and emergency department visits. Future research should examine the actionability of laboratory test values to determine associations with healthcare outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01250-0.
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Affiliation(s)
- Kevin Wiley
- Department of Healthcare Leadership and Management, Medical University of South Carolina (MUSC), 151-B Rutledge Avenue, Charleston, SC USA
| | - Justin Blackburn
- Department of Health Policy and Management Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, IN USA
| | | | - Nir Menachemi
- Department of Health Policy and Management Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, IN USA
| | - Mary De Groot
- Diabetes Translational Research Center, School of Medicine, Indiana University, Bloomington, United States
| | - Joshua R. Vest
- Department of Health Policy and Management Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, IN USA
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AbuHammad GAR, Naser AY, Hassouneh LKM. Diabetes mellitus-related hospital admissions and prescriptions of antidiabetic agents in England and Wales: an ecological study. BMC Endocr Disord 2023; 23:102. [PMID: 37149604 PMCID: PMC10163802 DOI: 10.1186/s12902-023-01352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Around 6.5% of the population in the United Kingdom has been diagnosed with diabetes. It is associated with several long-term consequences and higher hospitalization rates. AIM To examine the profile of hospital admissions related to diabetes mellitus and the prescription rates of antidiabetic medications in England and Wales. METHOD This is an ecological study that was conducted for the period between April 1999 and April 2020 using publicly available hospitalisation data in England and Wales. Hospital admission data for patients of all ages was extracted from Hospital Episode Statistics in England and the Patient Episode Database for Wales. The difference between admission rates in 1999 and 2020, as well as the difference between diabetes mellitus medication prescription rates in 2004 and 2020, were assessed using the Pearson Chi-squared test. A Poisson regression model with robust variance estimation was used to examine the trend in hospital admissions. RESULTS A total of 1,757,892 diabetes mellitus hospital admissions were recorded in England and Wales during the duration of the study. The hospital admission rate for diabetes mellitus increased by 15.2%. This increase was concomitant with an increase in the antidiabetic medication prescribing rate of 105.9% between 2004 and 2020. Males and those in the age group of 15-59 years had a higher rate of hospital admission. The most common causes of admissions were type 1 diabetes mellitus related complications, which accounted for 47.1% of all admissions. CONCLUSION This research gives an in-depth overview of the hospitalization profile in England and Wales during the previous two decades. In England and Wales, people with all types of diabetes and related problems have been hospitalized at a high rate over the past 20 years. Male gender and middle age were significant determinants in influencing admission rates. Diabetes mellitus type 1 complications were the leading cause of hospitalizations. We advocate establishing preventative and educational campaigns to promote the best standards of care for individuals with diabetes in order to lower the risk of diabetes-related complications.
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Affiliation(s)
- Gayda Abdel Rahman AbuHammad
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
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Novitski P, Cohen CM, Karasik A, Hodik G, Moskovitch R. Temporal patterns selection for All-Cause Mortality prediction in T2D with ANNs. J Biomed Inform 2022; 134:104198. [PMID: 36100163 DOI: 10.1016/j.jbi.2022.104198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/10/2022] [Accepted: 09/03/2022] [Indexed: 01/02/2023]
Abstract
Mortality prevention in T2D elderly population having Chronic Kidney Disease (CKD) may be possible thorough risk assessment and predictive modeling. In this study we investigate the ability to predict mortality using heterogeneous Electronic Health Records data. Temporal abstraction is employed to transform the heterogeneous multivariate temporal data into a uniform representation of symbolic time intervals, from which then frequent Time Intervals Related Patterns (TIRPs) are discovered. However, in this study a novel representation of the TIRPs is introduced, which enables to incorporate them in Deep Learning Networks. We describe here the use of iTirps and bTirps, in which the TIRPs are represented by a integer and binary vector representing the time respectively. While bTirp represents whether a TIRP's instance was present, iTirp represents whether multiple instances were present. While the framework showed encouraging results, a major challenge is often the large number of TIRPs, which may cause the models to under-perform. We introduce a novel method for TIRPs' selection method, called TIRP Ranking Criteria (TRC), which is consists on the TIRP's metrics, such as the differences in its recurrences, its frequencies, and the average duration difference between the classes. Additionally, we introduce an advanced version, called TRC Redundant TIRP Removal (TRC-RTR), TIRPs that highly correlate are candidates for removal. Then the selected subset of iTirp/bTirps is fed into a Deep Learning architecture like a Recurrent Neural Network or a Convolutional Neural Network. Furthermore, a predictive committee is utilized in which raw data and iTirp data are both used as input. Our results show that iTirps-based models that use a subset of iTirps based on the TRC-RTR method outperform models that use raw data or models that use full set of discovered iTirps.
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Affiliation(s)
- Pavel Novitski
- Software and Information Systems Engineering, Ben Gurion University, Beer-Sheva, Israel.
| | - Cheli Melzer Cohen
- Maccabi Data Science Institute, Maccabi Healthcare Services, Tel-Aviv, Israel.
| | - Avraham Karasik
- Maccabi Data Science Institute, Maccabi Healthcare Services, Tel-Aviv, Israel.
| | - Gabriel Hodik
- Maccabi Data Science Institute, Maccabi Healthcare Services, Tel-Aviv, Israel.
| | - Robert Moskovitch
- Software and Information Systems Engineering, Ben Gurion University, Beer-Sheva, Israel; Population Health and Science, Ichan Medical School at Mount Sinai, NYC, USA.
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Aro AK, Karjalainen M, Tiihonen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P. Use of primary health care services among older patients with and without diabetes. BMC PRIMARY CARE 2022; 23:233. [PMID: 36085026 PMCID: PMC9463776 DOI: 10.1186/s12875-022-01844-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/02/2022] [Indexed: 11/12/2022]
Abstract
Background The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes. Methods Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination. Results Before the onset of the study, the patients with diabetes had more doctor’s appointments (p < 0.001), nurse’s appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor’s appointments (p = 0.002), nurse’s appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16–5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse’s appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07–1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88–1.24). Conclusions Patients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.
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Friel KM, McCauley C, O’Kane M, McCann M, Delaney G, Coates V. Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:883283. [PMID: 36992734 PMCID: PMC10012072 DOI: 10.3389/fcdhc.2022.883283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 06/19/2023]
Abstract
Aim To examine the efficacy of clinical practice strategies in improving clinical outcomes and reducing length of hospital stay for inpatients with Type 1 and Type 2 diabetes. Background People living with diabetes are at increased risk of being admitted to hospital and to stay in hospital longer than those who do not have the condition. Diabetes and its complications cause substantial economic loss to those living with the condition, their families, to health systems and national economies through direct medical costs and loss of work and wages. Length of stay is a major factor driving up hospitalisation costs relating to those with Type 1 and Type 2 diabetes with suboptimal blood glucose management, hypoglycaemia, hyperglycaemia, and co-morbidities shown to considerably impact upon length of stay. The identification of attainable evidence-based clinical practice strategies is necessary to inform the knowledge base and identify service improvement opportunities that could lead to improved clinical outcomes for these patients. Study Design A systematic review and narrative synthesis. Methods A systematic search of CINAHL, Medline Ovid, and Web of Science databases was carried out to identify research papers reporting on interventions that have reduced length of hospital stay for inpatients living with diabetes for the period 2010-2021. Selected papers were reviewed, and relevant data extracted by three authors. Eighteen empirical studies were included. Results Eighteen studies spanned the themes of clinical management innovations, clinical education programmes, multidisciplinary collaborative care and technology facilitated monitoring. The studies demonstrated improvements in healthcare outcomes such as glycaemic control, greater confidence with insulin administration and reduced occurrences of hypoglycaemia and hyperglycaemia and decreased length of hospital stay and healthcare costs. Conclusions The clinical practice strategies identified in this review contribute to the evidence base for inpatient care and treatment outcomes. The implementation of evidence-based research can improve clinical practice and show that appropriate management can enhance clinical outcomes for the inpatient with diabetes, potentially leading to reductions in length of stay. Investment in and commissioning of practices that have the potential to afford clinical benefits and reduce length of hospital stay could influence the future of diabetes care. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204825, identifier 204825.
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Affiliation(s)
- Kathleen Michelle Friel
- Department of Health and Life Sciences, Institute of Nursing and Health Research, Ulster University, Derry/Londonderry, Northern Ireland
| | - Claire McCauley
- Department of Health and Life Sciences, Institute of Nursing and Health Research, Ulster University, Derry/Londonderry, Northern Ireland
| | - Maurice O’Kane
- Clinical Chemical Laboratory, Altnagelvin Hospital, Western Health and Social Care Trust, Derry/Londonderry, Northern Ireland
| | - Michael McCann
- Department of Computing, Letterkenny Institute of Technology, Donegal, Ireland
| | - Geraldine Delaney
- Department of Health and Life Sciences, Institute of Nursing and Health Research, Ulster University, Derry/Londonderry, Northern Ireland
| | - Vivien Coates
- Department of Health and Life Sciences, Institute of Nursing and Health Research, Ulster University, Derry/Londonderry, Northern Ireland
- Altnagelvin Hospital, Western Health and Social Care Trust, Derry/Londonderry, Northern Ireland
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8
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All-cause mortality prediction in T2D patients with iTirps. Artif Intell Med 2022; 130:102325. [DOI: 10.1016/j.artmed.2022.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
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Patel N, Swami J, Pinkhasova D, Karslioglu French E, Hlasnik D, Delisi K, Donihi A, Siminerio L, Rubin DJ, Wang L, Korytkowski MT. Sex differences in glycemic measures, complications, discharge disposition, and postdischarge emergency room visits and readmission among non-critically ill, hospitalized patients with diabetes. BMJ Open Diabetes Res Care 2022; 10:10/2/e002722. [PMID: 35246452 PMCID: PMC8900035 DOI: 10.1136/bmjdrc-2021-002722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The purpose of this prospective observational cohort study was to examine sex differences in glycemic measures, diabetes-related complications, and rates of postdischarge emergency room (ER) visits and hospital readmissions in non-critically ill, hospitalized patients with diabetes. RESEARCH DESIGN AND METHODS Demographic data including age, body mass index, race, blood pressure, reason for admission, diabetes medications at admission and discharge, diabetes-related complications, laboratory data (hematocrit, creatinine, hemoglobin A1c, point-of-care blood glucose measures), length of stay (LOS), and discharge disposition were collected. Patients were followed for 90 days following hospital discharge to obtain information regarding ER visits and readmissions. RESULTS 120 men and 100 women consented to participate in this study. There were no sex differences in patient demographics, diabetes duration or complications, or LOS. No differences were observed in the percentage of men and women with an ER visit or hospital readmission within 30 (39% vs 33%, p=0.40) or 90 (60% vs 49%, p=0.12) days of hospital discharge. More men than women experienced hypoglycemia prior to discharge (18% vs 8%, p=0.026). More women were discharged to skilled nursing facilities (p=0.007). CONCLUSIONS This study demonstrates that men and women hospitalized with an underlying diagnosis of diabetes have similar preadmission glycemic measures, diabetes duration, and prevalence of diabetes complications. More men experienced hypoglycemia prior to discharge. Women were less likely to be discharged to home. Approximately 50% of men and women had ER visits or readmissions within 90 days of hospital discharge. TRIAL REGISTRATION NUMBER NCT03279627.
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Affiliation(s)
- Neeti Patel
- Department of Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Janya Swami
- Department of Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Kristin Delisi
- Department of Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Amy Donihi
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda Siminerio
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel J Rubin
- Department of Medicine/Endocrinology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Li Wang
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary T Korytkowski
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zale AD, Abusamaan MS, McGready J, Mathioudakis N. Development and validation of a machine learning model for classification of next glucose measurement in hospitalized patients. EClinicalMedicine 2022; 44:101290. [PMID: 35169690 PMCID: PMC8829081 DOI: 10.1016/j.eclinm.2022.101290] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inpatient glucose management can be challenging due to evolving factors that influence a patient's blood glucose (BG) throughout hospital admission. The purpose of our study was to predict the category of a patient's next BG measurement based on electronic medical record (EMR) data. METHODS EMR data from 184,361 admissions containing 4,538,418 BG measurements from five hospitals in the Johns Hopkins Health System were collected from patients who were discharged between January 1, 2015 and May 31, 2019. Index BGs used for prediction included the 5th to penultimate BG measurements (N = 2,740,539). The outcome was category of next BG measurement: hypoglycemic (BG ≤ 70 mg/dl), controlled (BG 71-180 mg/dl), or hyperglycemic (BG > 180 mg/dl). A random forest algorithm that included a broad range of clinical covariates predicted the outcome and was validated internally and externally. FINDINGS In our internal validation test set, 72·8%, 25·7%, and 1·5% of BG measurements occurring after the index BG were controlled, hyperglycemic, and hypoglycemic respectively. The sensitivity/specificity for prediction of controlled, hyperglycemic, and hypoglycemic were 0·77/0·81, 0·77/0·89, and 0·73/0·91, respectively. On external validation in four hospitals, the ranges of sensitivity/specificity for prediction of controlled, hyperglycemic, and hypoglycemic were 0·64-0·70/0·80-0·87, 0·75-0·80/0·82-0·84, and 0·76-0·78/0·87-0·90, respectively. INTERPRETATION A machine learning algorithm using EMR data can accurately predict the category of a hospitalized patient's next BG measurement. Further studies should determine the effectiveness of integration of this model into the EMR in reducing rates of hypoglycemia and hyperglycemia.
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Key Words
- AUC, area under receiver operating curve
- BG, blood glucose
- BMI, body mass index
- CGM, continuous glucose monitor
- EMR, electronic medical record
- ICD, International Classification of Diseases
- ICU, intensive care unit
- NLR, negative likelihood ratio
- NPO, nil per os
- NPV, negative predictive value
- PLR, positive likelihood ratio
- PPV, positive predictive value
- T1DM, type 1 diabetes mellitus
- T2DM, type 2 diabetes mellitus
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Affiliation(s)
- Andrew D. Zale
- Associate Professor of Medicine, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street Suite 333, Baltimore, MD 21287, USA
| | - Mohammed S. Abusamaan
- Associate Professor of Medicine, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street Suite 333, Baltimore, MD 21287, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nestoras Mathioudakis
- Associate Professor of Medicine, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street Suite 333, Baltimore, MD 21287, USA
- Corresponding author.
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Olukotun O, Akinboboye O, Williams JS, Ozieh M, Egede LE. Influences of Demographic, Social Determinants, Clinical, Knowledge, and Self-Care Factors on Quality of Life in Adults With Type 2 Diabetes: Black-White Differences. J Racial Ethn Health Disparities 2021; 9:1172-1183. [PMID: 34009560 PMCID: PMC8602439 DOI: 10.1007/s40615-021-01058-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated racial differences in the contribution of demographic, social determinants, clinical, and self-care factors on quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). METHODS A total of 615 adults with T2DM in Southeastern United States were recruited. Linear regression models were used to assess the contribution of demographic, social determinants, clinical, and self-care factors on the mental (MCS) and physical components (PCS) of QOL, after stratifying by race. RESULTS For the entire sample, there were significant relationships between PCS and psychological distress (β = 0.02, p < 0.01), neighborhood aesthetics (β = 0.05, p < 0.01), neighborhood walking environment (β = -0.02, p < 0.05), access to healthy food (β = 0.01, p < 0.05), neighborhood crime (β = -0.15, p < 0.05), and neighborhood comparison (β = 0.13, p < 0.05); and MCS and depression (β = -0.06, p < 0.05), psychological distress (β = -0.09, p < 0.001), perceived stress (β = -0.12, p < 0.01), and perceived health status (β = -0.33, p < 0.01). In the regression models stratified by race, notable differences existed in the association between PCS, MCS, and demographic, psychosocial, built environment, and clinical factors among Whites and Blacks, respectively. CONCLUSION In this sample, there were racial differences in demographic, social determinants, built environment, and clinical factors associated with PCS and MCS components of QOL. Interventions may need to be tailored by race or ethnicity to improve quality of life in adults with T2DM.
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Affiliation(s)
| | - Olaitan Akinboboye
- Institute of Health and Equity, Department of Public and Community Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Mukoso Ozieh
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA.
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12
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Powers A, Winder M, Maurer M, Brittain K. Impact of inpatient diabetes transitions of care consult on glycemic control. PATIENT EDUCATION AND COUNSELING 2020; 103:1255-1257. [PMID: 32014273 DOI: 10.1016/j.pec.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE(S) An evaluation of a diabetes consult service for hospitalized patients was completed to determine effect on glycemic control. METHODS This medical record review was conducted to determine impact of a short-term program on patients with diabetes. The electronic medical record was used to identify patients diagnosed with diabetes mellitus and hospitalized from September 2016 to September 2017. A case-control design was utilized to compare patients with an inpatient order for the diabetes transitions of care service to those receiving usual care. The consultation service consisted of inpatient diabetes education and follow-up post discharge. The HbA1c reduction of adult inpatients those who completed a consult (n = 67) and those who received usual care (n = 67) were compared. Statistical analyses were conducted. RESULTS For the primary outcome of HbA1c reduction at 3 months, absolute difference from baseline to 3 months in the intervention was -2.9 % compared to 0.9 % in the control group (p < 0.001). CONCLUSIONS Participation in the service reduced HbA1c at 3 months and 6 months post-discharge, reduced 30-day all-cause readmissions, and increased percentage of patients with HbA1c <9.0 % at 6 months post-discharge. PRACTICAL IMPLICATIONS A consult-based diabetes transitions of care service decreased HbA1c versus usual care.
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Affiliation(s)
- Ashleigh Powers
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
| | - Marquita Winder
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States.
| | - MaryAnne Maurer
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
| | - Kevin Brittain
- Columbia VA Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209, United States
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13
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Leão AD, Alvarez-Lorenzo C, Soares-Sobrinho JL. One-pot synthesis of the organomodified layered double hydroxides - glibenclamide biocompatible nanoparticles. Colloids Surf B Biointerfaces 2020; 193:111055. [PMID: 32403034 DOI: 10.1016/j.colsurfb.2020.111055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/27/2020] [Accepted: 04/12/2020] [Indexed: 02/07/2023]
Abstract
In this work, synthesis of sodium dodecyl sulfate (SDS) organomodified LDH Zn2Al carrying glibenclamide (GLIB) was performed in one step and in one-pot to obtain nanoparticles (NP). XRD data showed GLIB adsolubilization (d = 14.03 Å) and NP coating with Eudragit L100®. In addition, thermal and XRD data showed exfoliated/intercalated nanocomposite for NP S5 (LDH associated with SDS and Eudragit L100®). LDH organophilization and GLIB intercalation reduced surface area (SBET 23.58 m2/g) and NP size (469 nm). In addition, the change in zeta potential (-35.5 ζ) relative to pristine LDH (SBET 41.34 m2/g, 688.8 nm and +14 ζ) indicated that LDH functionalization seems an appropriate approach to produce NP with greater colloidal stability and enhanced functionality. The zinc release data from the LDH matrix (2.96 % ±0.002 ppm) showed the effectiveness of the coating in acid medium (pH 1.2) and the release data from GLIB showed the kinetics of release of zero order with release in simulated intestinal medium (pH 7.4) of 88 % and 73 % (24 h) for uncoated and coated NP, respectively. All NP were considered biocompatible in the WST-1 assay on BALB 3T3 fibroblast strains making these NP promising therapeutically.
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Affiliation(s)
- Amanda Damasceno Leão
- Federal University of Pernambuco-UFPE, Department of Pharmaceutical Sciences, University city, Recife, Brazil.
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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14
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Novitski P, Cohen CM, Karasik A, Shalev V, Hodik G, Moskovitch R. All-Cause Mortality Prediction in T2D Patients. Artif Intell Med 2020. [DOI: 10.1007/978-3-030-59137-3_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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15
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Abstract
BACKGROUND AND AIMS Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities. STUDY We analyzed data from the National Inpatient Sample (NIS), years 2009 to 2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complications with inpatient mortality. RESULTS Our cohort included 553,017 patients with cirrhosis admitted from 2009 to 2013. Women made up 39% of the cohort; median age was 57 with 66% non-Hispanic white. Women were more likely than men to have noncirrhosis comorbidities, including diabetes and hypertension but were less likely to have most cirrhosis complications, including ascites and variceal bleeding. Women were more likely than men to have acute bacterial infections (34.9% vs. 28.2%; P<0.001), and were less likely than men to die in the hospital on univariable (odds ratio, 0.88; 95% confidence interval, 0.86-0.90; P<0.001) and multivariable (odds ratio, 0.86; 95% confidence interval, 0.83-0.88; P<0.001) analysis. CONCLUSIONS In patients hospitalized with cirrhosis, women have lower rates of hepatic decompensating events and higher rates of nonhepatic comorbidities and infections, resulting in lower in-hospital mortality. Understanding differences in indications for and disposition following hospitalization may help with the development of gender-specific cirrhosis management programs to improve long-term outcomes in women and men living with cirrhosis.
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16
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Dennis S, Taggart J, Yu H, Jalaludin B, Harris MF, Liaw ST. Linking observational data from general practice, hospital admissions and diabetes clinic databases: can it be used to predict hospital admission? BMC Health Serv Res 2019; 19:526. [PMID: 31357992 PMCID: PMC6661817 DOI: 10.1186/s12913-019-4337-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Linking process of care data from general practice (GP) and hospital data may provide more information about the risk of hospital admission and re-admission for people with type-2 diabetes mellitus (T2DM). This study aimed to extract and link data from a hospital, a diabetes clinic (DC). A second aim was to determine whether the data could be used to predict hospital admission for people with T2DM. METHODS Data were extracted using the GRHANITE™ extraction and linkage tool. The data from nine GPs and the DC included data from the two years prior to the hospital admission. The date of the first hospital admission for patients with one or more admissions was the index admission. For those patients without an admission, the census date 31/03/2014 was used in all outputs requiring results prior to an admission. Readmission was any admission following the index admission. The data were summarised to provide a comparison between two groups of patients: 1) Patients with a diagnosis of T2DM who had been treated at a GP and had a hospital admission and 2) Patients with a diagnosis of T2DM who had been treated at a GP and did not have a hospital admission. RESULTS Data were extracted for 161,575 patients from the three data sources, 644 patients with T2DM had data linked between the GPs and the hospital. Of these, 170 also had data linked with the DC. Combining the data from the different data sources improved the overall data quality for some attributes particularly those attributes that were recorded consistently in the hospital admission data. The results from the modelling to predict hospital admission were plausible given the issues with data completeness. CONCLUSION This project has established the methodology (tools and processes) to extract, link, aggregate and analyse data from general practices, hospital admission data and DC data. This study methodology involved the establishment of a comparator/control group from the same sites to compare and contrast the predictors of admission, addressing a limitation of most published risk stratification and admission prediction studies. Data completeness needs to be improved for this to be useful to predict hospital admissions.
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Affiliation(s)
- Sarah Dennis
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
| | - Jane Taggart
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Hairong Yu
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Siaw-Teng Liaw
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW 2052 Australia
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17
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O'Neill KN, McHugh SM, Tracey ML, Fitzgerald AP, Kearney PM. Health service utilization and related costs attributable to diabetes. Diabet Med 2018; 35:1727-1734. [PMID: 30153351 DOI: 10.1111/dme.13806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
AIMS To estimate the health service use and direct healthcare costs attributable to diabetes using best available data and methods. METHODS A nationally representative sample of adults aged ≥50 years was analysed (n=8107). Health service use in the previous 12 months included the number of general practitioner visits, outpatient department visits, hospital admissions, and accident and emergency department attendances. Multivariable negative binomial regression was used to estimate the associations between diabetes and frequency of visits. Average marginal effects were applied to unit costs for each health service and extrapolated to the total population, calculating the incremental costs associated with diabetes. RESULTS The prevalence of diabetes was 8.0% (95% CI: 7.4, 8.6). In fully adjusted models, diabetes was associated with additional health service use. Compared to those without diabetes, people with diabetes have, on average, 1.49 (95% CI: 1.10, 1.88) additional general practitioner visits annually. Diabetes was associated with an 87% increase in outpatient visits, a 52% increase in hospital admissions and a 33% increase in accident and emergency department attendances (P<0.001). The incremental cost of this additional service use, nationally, is an estimated €88,894,421 annually, with hospital admissions accounting for 67% of these costs. CONCLUSION Using robust methods, we identified substantially increased service use attributable to diabetes across the health system. Our findings highlight the urgent need to invest in the prevention and management of diabetes.
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Affiliation(s)
- K N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - S M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - M L Tracey
- School of Public Health, University College Cork, Cork, Ireland
| | - A P Fitzgerald
- School of Public Health, University College Cork, Cork, Ireland
- Department of Statistics, University College Cork, Cork, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Cork, Ireland
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18
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Perioperative Factors Affecting the Length of Hospitalization After Shoulder Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 1:e026. [PMID: 30211358 PMCID: PMC6132328 DOI: 10.5435/jaaosglobal-d-17-00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To determine factors related to length of hospitalization after shoulder arthroplasty. Methods: A retrospective review identified patients who underwent shoulder arthroplasty between 2009 and 2012 at our institution. Factors were evaluated for their association with hospitalization length in a univariate model. Diagnoses were categorized into four groups: (1) osteoarthritis, cuff tear arthropathy, massive rotator cuff tear, or osteonecrosis; (2) acute fracture or fracture sequelae; (3) inflammatory arthropathy; and (4) failed shoulder arthroplasty. Significant factors were then evaluated using a multivariate model. Results: Four hundred twenty-five shoulder arthroplasties were identified (average age, 66.9 years). Arthroplasty type significantly affected hospitalization length. Significant factors for increased hospitalization using multivariate analysis were diabetes mellitus, American Society of Anesthesiologists score of 3 or 4, acute fracture or fracture sequelae diagnosis, inflammatory arthropathy, and a blood transfusion. Discussion: Independent factors using multivariate analysis are diabetes, an American Society of Anesthesiologists score ≥3, fracture or fracture sequelae, inflammatory arthritis, and a perioperative blood transfusion. Level of Evidence: Level III therapeutic study
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19
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Gianchandani RY, Pasquel FJ, Rubin DJ, Dungan KM, Vellanki P, Wang H, Anzola I, Gomez P, Hodish I, Lathkar-Pradhan S, Iyengar J, Umpierrez GE. THE EFFICACY AND SAFETY OF CO-ADMINISTRATION OF SITAGLIPTIN WITH METFORMIN IN PATIENTS WITH TYPE 2 DIABETES AT HOSPITAL DISCHARGE. Endocr Pract 2018; 24:556-564. [PMID: 29949432 DOI: 10.4158/ep-2018-0036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Few randomized controlled trials have focused on the optimal management of patients with type 2 diabetes (T2D) during the transition from the inpatient to outpatient setting. This multicenter open-label study explored a discharge strategy based on admission hemoglobin A1c (HbA1c) to guide therapy in general medicine and surgery patients with T2D. METHODS Patients with HbA1c ≤7% (53 mmol/mol) were discharged on sitagliptin and metformin; patients with HbA1c between 7 and 9% (53-75 mmol/mol) and those >9% (75 mmol/mol) were discharged on sitagliptinmetformin with glargine U-100 at 50% or 80% of the hospital daily dose. The primary outcome was change in HbA1c at 3 and 6 months after discharge. RESULTS Mean HbA1c on admission for the entire cohort (N = 253) was 8.70 ± 2.3% and decreased to 7.30 ± 1.5% and 7.30 ± 1.7% at 3 and 6 months ( P<.001). Patients with HbA1c <7% went from 6.3 ± 0.5% to 6.3 ± 0.80% and 6.2 ± 1.0% at 3 and 6 months. Patients with HbA1c between 7 and 9% had a reduction from 8.0 ± 0.6% to 7.3 ± 1.1% and 7.3 ± 1.3%, and those with HbA1c >9% from 11.3 ± 1.7% to 8.0 ± 1.8% and 8.0 ± 2.0% at 3 and 6 months after discharge (both P<.001). Clinically significant hypoglycemia (<54 mg/dL) was observed in 4%, 4%, and 7% among patients with a HbA1c <7%, 7 to 9%, and >9%, while a glucose <40 mg/dL was reported in <1% in all groups. CONCLUSION The proposed HbA1c-based hospital discharge algorithm using a combination of sitagliptin-metformin was safe and significantly improved glycemic control after hospital discharge in general medicine and surgery patients with T2D. ABBREVIATIONS BG = blood glucose; DPP-4 = dipeptidyl peptidase-4; eGFR = estimated glomerular filtration rate; HbA1c = hemoglobin A1c; T2D = type 2 diabetes.
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20
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Korbel L, Easterling RS, Punja N, Spencer JD. The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System study. Pediatr Diabetes 2018; 19:512-519. [PMID: 29094435 DOI: 10.1111/pedi.12594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/19/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with diabetes mellitus (DM) have increased infection risk. The healthcare utilization of pediatric and adolescent diabetic patients with infection is not well defined. This study evaluates the number of pediatric and adolescent patients with DM that seek medical treatment for infection management and assesses its socioeconomic impact. METHODS A retrospective analysis was performed using the Pediatric Health Information System (PHIS) database on children and adolescents with DM who presented to the Emergency Department (ED) or were hospitalized for infection management from 2008 to 2014. The PHIS database collects admission, demographic, and economic data from 44 freestanding children's hospitals across the United States. RESULTS In total, 123 599 diabetic patient encounters were identified (77% type 1 DM, 23% type 2 DM). ED visits and hospitalizations for type 1 DM and type 2 DM increased throughout the study period. Total charges for these encounters were greater than $250 million dollars per year and increased each year. Infection encounters make up more than 30% of that cost while accounting for only 14% of the visits. Respiratory infections were the most common type of infection followed by skin and soft tissue infections for both ED care and inpatient hospitalizations. Patients with infections had longer hospital length of stay and higher cost per day than those without infections. CONCLUSIONS Children and adolescents with type 1 and type 2 DM commonly present to the ED and require hospitalization for infection evaluation and management. Encounters with infection make up a large proportion of a growing economic burden on the United States' healthcare system. As the prevalence of DM grows, this burden can be expected to become even more significant. Cost-effective strategies for the prevention of infection in pediatric patients with DM are needed.
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Affiliation(s)
- Lindsey Korbel
- Pediatrics Residency Program, Nationwide Children's Hospital, Columbus, Ohio
| | - Robert S Easterling
- College of Medicine and Life Sciences, The University of Toledo, Toledo, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nidhi Punja
- Data Resource Center, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - John David Spencer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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21
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Sajjad MA, Holloway KL, de Abreu LLF, Mohebbi M, Kotowicz MA, Pedler D, Pasco JA. Comparison of incidence, rate and length of all-cause hospital admissions between adults with normoglycaemia, impaired fasting glucose and diabetes: a retrospective cohort study in Geelong, Australia. BMJ Open 2018; 8:e020346. [PMID: 29574446 PMCID: PMC5875593 DOI: 10.1136/bmjopen-2017-020346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine whether adults with normoglycaemia, impaired fasting glucose (IFG) and diabetes differed according to the incidence, rate, length and primary reasons for hospital admission. DESIGN Retrospective cohort study. SETTING Barwon Statistical Division, Geelong, Australia. PARTICIPANTS Cohort included 971 men and 924 women, aged 20+ years, participating in the Geelong Osteoporosis Study. Glycaemic status was assessed at cohort entry using fasting plasma glucose, use of antihyperglycaemic medication and/or self-report. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was any admission to the major tertiary public hospital in the study region over the follow-up period. Secondary outcome measures were admission rate and length (days). RESULTS Over a median follow-up of 7.4 years (IQR 5.3-9.6), participants with diabetes, compared with those with normoglycaemia, were two times as likely to be hospitalised (OR 2.07, 95% CI 1.42 to 3.02), had a higher admission rate (incidence rate ratio 1.61, 95% CI 1.17 to 2.23) and longer hospital stay (third quartile difference 7.7, 95% CI 1.3 to 14.1 and ninth decile difference 16.2, 95% CI 4.2 to 28.3). IFG group was similar to normoglycaemia for the incidence, rate and length of admission. Cardiovascular disease-related diagnoses were the most common primary reasons for hospitalisation across all glycaemic categories. CONCLUSIONS Our results show increased incidence, rate and length of all-cause hospital admission in adults with diabetes as compared with normoglycaemia; however, we did not detect any associations for IFG. Interventions should focus on preventing IFG-to-diabetes progression and reducing cardiovascular risk in IFG and diabetes.
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Affiliation(s)
| | | | | | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mark A Kotowicz
- Deakin University, Geelong, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | | | - Julie A Pasco
- Deakin University, Geelong, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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22
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Profili F, Bellini I, Zuppiroli A, Seghieri G, Barbone F, Francesconi P. Changes in diabetes care introduced by a Chronic Care Model-based programme in Tuscany: a 4-year cohort study. Eur J Public Health 2018; 27:14-19. [PMID: 28177441 DOI: 10.1093/eurpub/ckw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In 2010, Tuscany (Italy) implemented a Chronic Care Model (CCM)-based programme for the management of chronic diseases. The study’s objective was to evaluate its impact on the care of patients with type 2 diabetes. Methods A population-based cohort study was performed on patients with diabetes, identified by an administrative data algorithm, exposed to a CCM-based programme versus patients not exposed (8486 patients in each group). The groups were matched using a propensity score approach and observed from 2011 to 2014. The outcomes measured were: mortality rate and hazard ratio (HR), hospitalisation incidence rate (IR) (all causes and diabetes-related diseases) and incidence rate ratio (IRR), and Guideline Composite Indicator (GCI) as proxy of adherence to guidelines (IR and IRR). Stratified Cox regression analysis and conditional fixed effect Poisson regression analyses were performed to compute HR and IRR. Results A significant improvement was observed for GCI (IRR 1.58; 95% CI 1.53–1.62) and for cardiovascular long-term complications (IRR 1.11; 95% CI 1.04–1.18). A protective effect was observed for neurological long-term complications (IRR 0.85; 95% CI 0.76–0.95), acute cardio-cerebrovascular long-term complications—stroke and ST segment elevation myocardial infarction—(IRR 0.81; 95% CI 0.71–0.92) and mortality (HR 0.88; 95% CI 0.81–0.96). Conclusion The implementation of a CCM-based programme was followed by better management and benefits for the health status of patients. The increase in hospitalisations for cardiovascular long-term complications could engender cost-efficacy issues, but a better integrated care (GPs and specialists) and a more appropriate specialist outpatient services organisation could avoid a part of these, while still maintaining the benefits seen.
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Affiliation(s)
| | - Irene Bellini
- Medical Specialisation School of Hygiene and Preventive Medicine, Florence, Italy
| | | | | | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy.,Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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23
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Yeung RO, Cai JH, Zhang Y, Luk AO, Pan JH, Yin J, Ozaki R, Kong APS, Ma R, So WY, Tsang CC, Lau KP, Fisher E, Goggins W, Oldenburg B, Chan J. Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial. Clin Diabetes Endocrinol 2018. [PMID: 29541481 PMCID: PMC5842642 DOI: 10.1186/s40842-018-0055-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. Methods We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Results Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35-0·79;p = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=-0.218, p = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p = < 0.001) and that of peer support and heart disease (Est = 0.455, p = 0.001). Conclusions In type 2 diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities. Trial registration NCT00950716 Registered July 31, 2009.
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Affiliation(s)
- Roseanne O Yeung
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, 9-111K Clinical Science Building, 11350 83 Avenue, Edmonton, AB T6G 2G3 Canada.,3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | | | - Yuying Zhang
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Andrea O Luk
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Junmei Yin
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Risa Ozaki
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Alice P S Kong
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Ronald Ma
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Wing-Yee So
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Chiu Chi Tsang
- 4Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - K P Lau
- North District Hospital, Sheung Shui, Hong Kong
| | - Edwin Fisher
- 6University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - Julianna Chan
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
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Rosa MQM, Rosa RDS, Correia MG, Araujo DV, Bahia LR, Toscano CM. Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E294. [PMID: 29419786 PMCID: PMC5858363 DOI: 10.3390/ijerph15020294] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/20/2018] [Accepted: 02/01/2018] [Indexed: 01/04/2023]
Abstract
Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies.
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Affiliation(s)
| | - Roger Dos Santos Rosa
- Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Marcelo G Correia
- Biostatistics and Bioinformatics Department, National Institute of Cardiology, Rio de Janeiro 22240-006, Brazil.
| | - Denizar V Araujo
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | - Luciana R Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | - Cristiana M Toscano
- Collective Health Department, Federal University of Goiás, Goiânia 75345-000, Brazil.
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Lee SM, Choi IS, Han E, Suh D, Shin EK, Je S, Lee SS, Suh DC. Incremental Treatment Costs Attributable to Overweight and Obesity in Patients with Diabetes: Quantile Regression Approach. Obesity (Silver Spring) 2018; 26:223-232. [PMID: 29178436 DOI: 10.1002/oby.22080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to estimate treatment costs attributable to overweight and obesity in patients with diabetes who were less than 65 years of age in the United States. METHODS This study used data from the Medical Expenditure Panel Survey from 2001 to 2013. Patients with diabetes were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification code (250), clinical classification codes (049 and 050), or self-reported physician diagnoses. Total treatment costs attributable to overweight and obesity were calculated as the differences in the adjusted costs compared with individuals with diabetes and normal weight. Adjusted costs were estimated by using generalized linear models or unconditional quantile regression models. RESULTS The mean annual treatment costs attributable to obesity were $1,852 higher than those attributable to normal weight, while costs attributable to overweight were $133 higher. The unconditional quantile regression results indicated that the impact of obesity on total treatment costs gradually became more significant as treatment costs approached the upper quantile. CONCLUSIONS Among patients with diabetes who were less than 65 years of age, patients with diabetes and obesity have significantly higher treatment costs than patients with diabetes and normal weight. The economic burden of diabetes to society will continue to increase unless more proactive preventive measures are taken to effectively treat patients with overweight or obesity.
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Affiliation(s)
- Seung-Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - In-Sun Choi
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei University, Incheon, South Korea
| | - David Suh
- School of Public Health, Columbia University, New York, New York, USA
| | - Eun-Kyung Shin
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Seyunghe Je
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Sung Su Lee
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Dong-Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
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Wolters RJ, Braspenning JCC, Wensing M. Impact of primary care on hospital admission rates for diabetes patients: A systematic review. Diabetes Res Clin Pract 2017; 129:182-196. [PMID: 28544924 DOI: 10.1016/j.diabres.2017.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022]
Abstract
High-quality primary care for diabetes patients may be related to lowered hospital admissions. A systematic search was performed to assess the impact of structure, process, and outcome of primary diabetes care on hospital admission rates, considering patient characteristics. Studies on diabetes patients in primary care with hospitalisation rates as outcomes published between January 1996 and December 2015 were included. Indicators of quality of care (access, continuity and structure of care, process, and outcome indicators) and patient characteristics (age, gender, ethnicity, insurance, socio-economic status, diabetes characteristics, co-morbidity, and health-related lifestyle) were extracted. After assessment of the strength of evidence, characteristics of care and diabetes patients were presented in relation to the likelihood of hospitalisation. Thirty-one studies were identified. A regular source of primary care and a well-controlled HbA1c level decreased the likelihood of hospitalisation. Other aspects of care were less consistent. Patients' age, co-morbidity, and socio-economic status were related to higher hospitalisation. Gender and health-related lifestyle showed no relationship. Studies were heterogeneous in design, sample, and healthcare system. Different definitions of diabetes and unscheduled admissions limited comparisons. In healthcare systems where diabetes patients have a regular source of primary care, hospital admission rates cannot be meaningfully related to primary care characteristics.
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Affiliation(s)
- R J Wolters
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein 21, 114 IQ Healthcare, 6525 EZ Nijmegen, The Netherlands.
| | - J C C Braspenning
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein 21, 114 IQ Healthcare, 6525 EZ Nijmegen, The Netherlands.
| | - M Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein 21, 114 IQ Healthcare, 6525 EZ Nijmegen, The Netherlands; Department of General Practice and Health Services Research Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
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Becerra MB, Allen NL, Becerra BJ. Food insecurity and low self-efficacy are associated with increased healthcare utilization among adults with type II diabetes mellitus. J Diabetes Complications 2016; 30:1488-1493. [PMID: 27474705 DOI: 10.1016/j.jdiacomp.2016.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/03/2016] [Accepted: 07/15/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Food insecurity has been shown to negatively impact health outcomes, disease management and hospitalizations. Despite the increasing burden of type II diabetes mellitus (T2DM) in the United States, little research exists on the role of food insecurity and its association to T2DM-related healthcare utilization. The purpose of our study was to address such a gap in the literature by evaluating the role of food insecurity and T2DM-related past 12-month hospitalization or emergency department (ED) admission among adults with healthcare professional diagnosed T2DM. METHODS We utilized the California Health Interview Survey (CHIS), 2009, 2011/2012 data to select CHIS participants who were aged 18 or older and reported doctor diagnosis of T2DM; resulting in a total of 8252 participants. Food insecurity was defined as: living at or above 200% federal poverty level (FPL), living below 200% FPL but food secure, living below 200% FPL and food insecure. A secondary exposure variable of interest was self-efficacy, based on the CHIS-provided variable of confidence to manage T2DM. All analyses were survey weighted with alpha less than .05 noting significance. RESULTS Those with low food security (12.96%) and low-self efficacy (15.14%), reported significantly higher prevalence of T2DM-related healthcare utilization, as compared to their counterparts. Both living with low food security and having low self-efficacy were also associated with over two-fold increase in healthcare utilization. CONCLUSION Our results demonstrate the cumulative need for community-based resources to improve the continuum of care and ensure that such at-risk populations have adequate resources for disease management.
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Affiliation(s)
- Monideepa B Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, United States.
| | | | - Benjamin J Becerra
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, United States
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Lin W, Chen C, Guan H, Du X, Li J. Hospitalization of elderly diabetic patients: characteristics, reasons for admission, and gender differences. BMC Geriatr 2016; 16:160. [PMID: 27595573 PMCID: PMC5011894 DOI: 10.1186/s12877-016-0333-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/27/2016] [Indexed: 12/24/2022] Open
Abstract
Background Understanding the differences in characteristics, gender, and common causes for admission in hospitalized elderly diabetic patients provides a theoretical basis for their successful management. This study explored the reasons and gender differences in hospitalizations of elderly patients with diabetes mellitus. Methods Patients aged ≥60 years who had received a diagnosis of diabetes by the time of discharge, from 1 January 2011 to 1 January 2014, were retrospectively enrolled. Hospitalization data of the patients were collected, and reasons for hospitalization were analyzed based on chief complaints and principle diagnosis. Results The most frequent reasons stated for admission were related to the chronic complications of diabetes (42.1 %), seconded by hyperglycemia (26.4 %) and infection (15.7 %). Ketonuria, ketonemia, or diabetic ketoacidosis was more commonly seen in women than men, whereas diabetic nephropathy and neoplasms were more frequently found in men than women. Regarding infection as a cause of hospitalization, the 4 main types were respiratory tract (44.5 %), urinary tract (20.3 %), gastrointestinal (14.8 %), and skin and soft tissue (10.9 %). Respiratory tract infection was significantly more common in men (61.4 %) than women (31 %, P = 0.001), whereas urinary tract infection was more frequent in women (29.6 %) than men (8.8 %, P = 0.004). Conclusion The most frequent reasons for hospital admission in elderly diabetic patients were chronic complications of diabetes, hyperglycemia, and infection. Men and women differed in reasons for hospital admission.
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Affiliation(s)
- Wei Lin
- Department of Geriatrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Science and Technology Information Center, Wenzhou Medical University Library, Wenzhou, China
| | - Chan Chen
- Department of Geriatrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huaqin Guan
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaohong Du
- Department of Geriatrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junjian Li
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Risk of hospitalization in patients with diabetes mellitus who have solid-organ malignancy. Future Sci OA 2016. [DOI: 10.4155/fsoa-2016-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: To determine the relationship between diabetes mellitus (DM) and hospitalization risk in patients with solid-organ malignancies, hospitalized patients with a new solid-organ malignancy and DM were retrospectively analyzed. Results: The presence of DM conferred a 72% greater chance (odds ratio [OR]: 1.72, 95% CI: 1.46–2.04; p < 0.01) of requiring any hospitalization and increased the chances of having multiple admissions by 84% (OR: 1.84, 95% CI: 1.53–2.21; p < 0.01). Additionally, the presence of DM increased the duration of hospital stay by 0.57 days (p < 0.01). Conclusion: The presence of DM in patients with solid-organ malignancies increases the risk of any hospitalization, multiple hospitalizations and length of hospital stay.
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Solimini AG, D'Addario M, Villari P. Ecological correlation between diabetes hospitalizations and fine particulate matter in Italian provinces. BMC Public Health 2015. [PMID: 26208978 PMCID: PMC4514955 DOI: 10.1186/s12889-015-2018-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Exposure to particulate matter has been associated with increased risk of cardiovascular and respiratory diseases. We evaluated the ecological correlation between standardized hospital discharges with diabetes in Italian provinces and fine particulate matter (PM2.5) adjusting for common risk factors, socioeconomic factors and differences in hospitalization appropriateness. Methods We used cross sectional data aggregated at the province level and available from official institutional databases for years 2008–2010. Covariates included prevalence of adult overweight, obese, smokers, physically inactive, education and income (as average gross domestic product per person, GDP). We reduced the number of covariates to a smaller number of factors for the subsequent statistical model by extracting meaningful components using principal component analysis (PCA). Log-linear multiple regression analysis was used to model diabetes hospital discharges with PCA components and PM2.5 levels and hospitalization appropriateness for men and women. Results The first PCA components for both men and women were characterized by larger loadings of risk factors (obesity, overweight, physical inactivity, cigarette smoking) and lower socioeconomic factors (educational level and mean GDP). Diabetes hospitalization increases with the first PCA component and decreases with the index of hospitalization appropriateness. In fully adjusted models, diabetes hospitalizations increase with increasing annual PM2.5 concentrations, with a rise of 3.5 % (1.3 %–5.6 %) for men and of 4.0 % (1.5 %-6.4 %) for women per unit of PM2.5 increase. Conclusions We found a significant ecological relationship between sex and age standardised hospital discharge with diabetes as principle diagnosis and mean annual PM2.5 concentrations in Italian provinces, once that covariates have been accounted for. The relationship was robust to different means of estimating PM2.5 exposure. A large portion of the variance of diabetes hospitalizations was linked to differences of hospital care appropriateness between Italian regions and this variable should routinely be included in ecological analyses of hospitalizations.
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Affiliation(s)
- Angelo G Solimini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Maddalena D'Addario
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Spatial analysis of hospitalization rate for diabetes mellitus and its complications in the Brazilian population, 2007–2011. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0421-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Asao K, McEwen LN, Lee JM, Herman WH. Ascertainment of outpatient visits by patients with diabetes: The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). J Diabetes Complications 2015; 29:650-8. [PMID: 25891975 PMCID: PMC4458198 DOI: 10.1016/j.jdiacomp.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/22/2022]
Abstract
AIMS To estimate and evaluate the sensitivity and specificity of providers' diagnosis codes and medication lists to identify outpatient visits by patients with diabetes. METHODS We used data from the 2006 to 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We assessed the sensitivity and specificity of providers' diagnoses and medication lists to identify patients with diabetes, using the checkbox for diabetes as the gold standard. We then examined differences in sensitivity by patients' characteristics using multivariate logistic regression models. RESULTS The checkbox identified 12,647 outpatient visits by adults with diabetes among the 70,352 visits used for this analysis. The sensitivity and specificity of providers' diagnoses or listed diabetes medications were 72.3% (95% CI: 70.8% to 73.8%) and 99.2% (99.1% to 99.4%), respectively. Diabetic patients ≥75 years of age, women, non-Hispanics, and those with private insurance or Medicare were more likely to be missed by providers' diagnoses and medication lists. Diabetic patients who had more diagnosis codes and medications recorded, had glucose or hemoglobin A1c measured, or made office- rather than hospital-outpatient visits were less likely to be missed. CONCLUSIONS Providers' diagnosis codes and medication lists fail to identify approximately one quarter of outpatient visits by patients with diabetes.
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Affiliation(s)
- Keiko Asao
- Department of Preventive Medicine, The University of Tennessee Health Science Center, 66N. Pauline St., Ste. 633, Memphis, TN 38111, USA; Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, The University of Michigan, 1000 Wall St., Brehm Center Room 6111, Ann Arbor, MI 48105-5714, USA.
| | - Laura N McEwen
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, The University of Michigan, 1000 Wall St., Brehm Center Room 6111, Ann Arbor, MI 48105-5714, USA.
| | - Joyce M Lee
- Child Health Evaluation and Research Unit, Division of Pediatric Endocrinology, The University of Michigan, 300 North Ingalls St., Room 6E18, Ann Arbor, MI 48109-5456, USA.
| | - William H Herman
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, The University of Michigan, 1000 Wall St., Brehm Center Room 6111, Ann Arbor, MI 48105-5714, USA; Department of Epidemiology, The University of Michigan, 1000 Wall St., Brehm Center Room 6108, Ann Arbor, MI 48105-5714, USA.
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Comino EJ, Harris MF, Islam MDF, Tran DT, Jalaludin B, Jorm L, Flack J, Haas M. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res 2015; 15:12. [PMID: 25609196 PMCID: PMC4310177 DOI: 10.1186/s12913-014-0666-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increased prevalence of diabetes and its significant impact on use of health care services, particularly hospitals, is a concern for health planners. This paper explores the risk factors for all-cause hospitalisation and the excess risk due to diabetes in a large sample of older Australians. METHODS The study population was 263,482 participants in the 45 and Up Study. The data assessed were linked records of hospital admissions in the 12 months following completion of a baseline questionnaire. All cause and ambulatory care sensitive admission rates and length of stay were examined. The associations between demographic characteristics, socioeconomic status, lifestyle factors, and health and wellbeing and risk of hospitalisation were explored using zero inflated Poisson (ZIP) regression models adjusting for age and gender. The ratios of adjusted relative rates and 95% confidence intervals were calculated to determine the excess risk due to diabetes. RESULTS Prevalence of diabetes was 9.0% (n = 23,779). Age adjusted admission rates for all-cause hospitalisation were 631.3 and 454.8 per 1,000 participant years and the mean length of stay was 8.2 and 7.1 days respectively for participants with and without diabetes. In people with and without diabetes, the risk of hospitalisation was associated with age, gender, household income, smoking, BMI, physical activity, and health and wellbeing. However, the increased risk of hospitalisation was attenuated for participants with diabetes who were older, obese, or had hypertension or hyperlipidaemia and enhanced for those participants with diabetes who were male, on low income, current smokers or who had anxiety or depression. CONCLUSIONS This study is one of the few studies published to explore the impact of diabetes on hospitalisation in a large non-clinical population, the 45 and Up Study. The attenuation of risk associated with some factors is likely to be due to correlation between diabetes and factors such as age and obesity. The increased risk in association with other factors such as gender and low income in participants with diabetes is likely to be due to their synergistic influence on health status and the way services are accessed.
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Affiliation(s)
- Elizabeth Jean Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - M D Fakhrul Islam
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Duong Thuy Tran
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, Sydney and South Western Sydney Local Health Districts, Locked Bag 7017, Liverpool, NSW, 1871, Australia. .,School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia.
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia. .,Centre for Health Research, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jeff Flack
- Bankstown-Lidcombe Hospital, Eldridge Road, Bankstown, NSW, 2200, Australia.
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology, Sydney, PO Box 123, Broadway, NSW 2007, Level 4, 645 Harris Street, Ultimo, NSW, 2007, Australia.
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Ki M, Baek S, Yun YD, Kim N, Hyde M, Na B. Age-related differences in diabetes care outcomes in Korea: a retrospective cohort study. BMC Geriatr 2014; 14:111. [PMID: 25319086 PMCID: PMC4210558 DOI: 10.1186/1471-2318-14-111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/29/2014] [Indexed: 12/03/2022] Open
Abstract
Background Age-related differences in diabetes outcomes are important both for clinical and policy considerations. To clarify the basis of such differences, we investigated patterns of associations for age in relation to hospitalization and glycemic control and examined the role of other factors. Methods 4471 patients with diabetes aged 40–79 years were drawn from a retrospectively retrieved National Health Insurance Cohort. Using logistic regression, risk factors measured over the two years (2007–2008) were examined for their associations with hospitalization and poor glycemic control during the last year (2009) of follow-up. Results Compared to the middle-aged patients, older patients were more likely to have been hospitalized (Adjusted odds ratio (ORadjusted) = 1.97(95% CI = 1.28, 3.04) for the oldest group (ages 70–79) vs youngest group (ages 40–49)) but less likely to have poor glycemic control (ORadjusted = 0.45 (95% CI = 0.37, 0.56) for the oldest group vs youngest group). Older patients were also less likely to be obese but had more complications, longer duration of diabetes, lower continuity of care, and higher blood pressure and total cholesterol level. The pattern of associations for hospitalization and glycemic control was not uniform across the risk factors, sharing only a few common factors such as the duration of diabetes and blood pressure. In general, poor glycemic control was affected predominantly by metabolic management, while hospitalization was strongly related to functional status (i.e., number of complications) and care quality measures (i.e., continuity of care). Conclusion Hospitalization was higher among the older diabetic patients, despite better glycemic control. Factors were differently associated with the two diabetes-related outcomes, providing more comprehensive risk profiles for hospitalization. The co-existence of improved glycemic control and increased hospitalization among older diabetic patients suggests an extension of a geriatric evaluation to wider functional and comorbidity status.
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Affiliation(s)
| | | | | | | | | | - Baegju Na
- Department of Preventive Medicine, College of Medicine, Konyang University, Konyang Univ, Gwanjeo Campus, Gasuwon-dong, Seo-gu, Daejeon 302-833, Korea.
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Gulli G, Frasson S, Borzì V, Fontanella A, Grandi M, Marengo C, Nicolucci A, Pastorelli R, Solerte B, Gatti A, Raimondo FC, Bonizzoni E, Gussoni G, Mazzone A, Ceriello A. Effectiveness of an educational intervention on the management of type 2 diabetic patients hospitalized in Internal Medicine: results from the FADOI-DIAMOND study. Acta Diabetol 2014; 51:765-70. [PMID: 24722913 DOI: 10.1007/s00592-014-0585-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/24/2014] [Indexed: 12/24/2022]
Abstract
Appropriate management of hyperglycemia is crucial for patients with type 2 diabetes. Aim of the FADOI-DIAMOND study was to evaluate real-world management of type 2 diabetic patients hospitalized in Internal Medicine wards (IMW) and the effects of a standardized educational intervention for IMW staff. DIAMOND has been carried out in 53 Italian IMW, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase). In PRE phase, each center reviewed the charts of the last 30 hospitalized patients with known type 2 diabetes. An educational program was conducted in each center by means of the "outreach visit," a face-to-face meeting between IMW staff and a trained external expert. Six months after, each center repeated the data collection (POST phase), specular to the PRE. A total of 3,167 patients were enrolled (1,588 PRE and 1,579 POST). From PRE phase to POST, patients with registered anthropometric data (54.1 vs. 74.9 %, p < 0.001) and in-hospital/recent measurement of glycated hemoglobin (48.2 vs. 61.4 %, p < 0.005) increased significantly. After educational program, more patients received insulin during hospitalization (68.3 vs. 63.6 %, p = 0.005). A more relevant variation in glycemia during hospitalization was observed in POST phase than PRE (-22.2 vs. -15.5 mg/dL, p < 0.001), without differences as for occurrence of hypoglycemia (12.3 vs. 11.9 %). A one-shot educational intervention led to persistent improvement in the management of hospitalized patients with type 2 diabetes and to significant better glycemic control. Further studies might evaluate the effectiveness of a more aggressive educational program, on both management and outcomes.
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Affiliation(s)
- Giovanni Gulli
- Department of Internal Medicine, Major Hospital "SS. Annunziata", ASL CN1, Savigliano, Italy
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Rosa R, Nita ME, Rached R, Donato B, Rahal E. Estimated hospitalizations attributable to Diabetes Mellitus within the public healthcare system in Brazil from 2008 to 2010: study DIAPS 79. Rev Assoc Med Bras (1992) 2014; 60:222-30. [DOI: 10.1590/1806-9282.60.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
Objective: to estimate the number of hospitalizations attributable to diabetes mellitus (DM) and its complications within the public healthcare system in Brazil (SUS) and the mean cost paid per hospitalization. Methods: the official database from the Hospital Information System of the Unified Health System (SIH/SUS) was consulted from 2008 to 2010. The proportion of hospitalizations attributable to DM was estimated using attributable risk methodology. The mean cost per hospitalization corresponds to direct medical costs in nursing and intensive care, from the perspective of the SUS. Results: the proportion of hospitalizations attributable to DM accounted for 8.1% to 12.2% of total admissions in the period, varying according to use of maximum (self-reported with correction factor) or minimal (self-reported) DM prevalence. The hospitalization rate was 47 to 70.8 per 10.000 inhabitants per year. The mean cost per hospitalization varied from 1.302 Brazilian Reais (BRL) to 1,315 BRL. Assuming the maximum prevalence, hospitalizations were distributed as 10.3% as DM itself, 36.6% as chronic DM-associated complications and 53.1% as general medical conditions. Advancing age was accompanied by an increase in hospitalization rates and corresponding costs, and more pronounced in male patients. Conclusion: the results express the importance of DM in terms of the use of health care resources and demonstrate that studies of hospitalizations with DM as a primary diagnosis are not sufficient to assess the magnitude of the impact of this disease.
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Affiliation(s)
- Roger Rosa
- Federal University of Rio Grande do Sul, Brazil
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Li CL, Sheu JT, Wang TA, Wen YP, Chao M, Chang HY. The relationship between healthy lifestyle and hospital utilization among adults with diabetes: results from a national cohort in Taiwan. Asia Pac J Public Health 2014; 27:303-13. [PMID: 24566604 DOI: 10.1177/1010539514524817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.
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Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan
| | - Ji-Tian Sheu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Ting-Ann Wang
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Yu-Ping Wen
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Minston Chao
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Hsing-Yi Chang
- Division of Preventive Medicine and Health Service Research, Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
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Khalid JM, Raluy-Callado M, Curtis BH, Boye KS, Maguire A, Reaney M. Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK General Practice Research Database linked to English Hospital Episode Statistics. Int J Clin Pract 2014; 68:40-8. [PMID: 24112108 PMCID: PMC4282286 DOI: 10.1111/ijcp.12265] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/02/2013] [Accepted: 07/21/2013] [Indexed: 12/16/2022] Open
Abstract
AIMS To investigate the rates and risk of hospitalisations in patients with type 2 diabetes (T2D) mellitus in England. METHODS This retrospective population-based cohort study used computerised records from the General Practice Research Database linked to Hospital Episode Statistics data in England. Patients with T2D from January 2006 to December 2010 were selected. Primary outcome measures were all-cause, non-diabetes-related, diabetes-related and hypoglycaemia-related hospitalisations. Factors associated with all-cause and diabetes-related hospitalisations were investigated with Cox's proportional hazards models. RESULTS Amongst 97,689 patients with T2D, approximately 60% had at least one hospitalisation during the 4-year study period. Rates of hospitalisation were as follows: all-cause, 33.9 per 100 patient-years (pt-yrs); non-diabetes-related, 29.1 per 100 pt-yrs; diabetes-related, 18.8 per 100 pt-yrs and hypoglycaemia, 0.3 per 100 pt-yrs. The risk of all-cause hospitalisation increased with hospitalisation in the previous year, insulin use and the presence of major comorbidities. The risk of a diabetes-related hospitalisation increased with age, female gender, insulin use, chronic renal insufficiency, hypoglycaemia (as diagnosed by a general practitioner) and diabetes-related hospitalisation in the previous year. CONCLUSIONS Patients with T2D are hospitalised at a considerably high rate for causes directly related with diabetes complications and stay longer in hospital. History of hospitalisation and complications of diabetes were found to be predictive of inpatient hospitalisations suggesting previous hospitalisation episodes could serve as points of intervention. This study highlights important areas for healthcare intervention and provides a reminder for vigilance when risk factors for hospitalisation in patients with T2D are present.
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Affiliation(s)
- J M Khalid
- Epidemiology and Database Analytics, Evidera, London, UK
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Ronksley PE, Ravani P, Sanmartin C, Quan H, Manns B, Tonelli M, Hemmelgarn BR. Patterns of engagement with the health care system and risk of subsequent hospitalization amongst patients with diabetes. BMC Health Serv Res 2013; 13:399. [PMID: 24103159 PMCID: PMC3851786 DOI: 10.1186/1472-6963-13-399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/04/2013] [Indexed: 12/13/2022] Open
Abstract
Background Re-hospitalization is common among patients with diabetes, and may be related to aspects of health care use. We sought to determine the association between patterns of health care engagement and risk of subsequent hospitalization within one year of discharge for patients with diabetes. Methods We identified adults with incident diabetes in Alberta, Canada, who had at least one hospitalization following their diabetes diagnosis between January 1, 2004 and March 31, 2011. We used Cox regression to estimate the association between factors related to health care engagement (prior emergency department use, primary care visits, and discharge disposition (i.e. whether the patient left against medical advice)) and the risk of subsequent all-cause hospitalization within one year. Results Of the 33811 adults with diabetes and at least one hospitalization, 11095 (32.8%) experienced a subsequent all-cause hospitalization within a mean (standard deviation) follow-up time of 0.68 (0.3) years. Compared to patients with no emergency department visits, there was a 4 percent increased risk of a subsequent hospitalization for every emergency department visit occurring prior to the index hospitalization (adjusted Hazard Ratio [HR]: 1.04; 95% CI: 1.03–1.05). Limited and increased use of primary care was also associated with increased risk of a subsequent hospitalization. Compared to patients with 1–4 visits, patients with no visits to a primary care physician (adjusted HR: 1.11; 95% CI: 0.99–1.25) and those with 5–9 visits (adjusted HR: 1.06; 95% CI: 1.00–1.12) were more likely to experience a subsequent hospitalization. Finally, compared to patients discharged home, those leaving against medical advice were more likely to have a subsequent hospitalization (adjusted HR: 1.74; 95% CI: 1.50–2.02) and almost 3 times more likely to have a diabetes-specific subsequent event (adjusted HR: 2.86; 95% CI: 1.82–4.49). Conclusions Patterns of health care use and the circumstances surrounding hospital discharge are associated with an increased risk of subsequent hospitalization among patients with diabetes. Whether these patterns are related to the health care systems ability to manage complex patients within a primary care setting, or to access to primary care services, remains to be determined.
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Affiliation(s)
- Paul E Ronksley
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
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Bo S, Ciccone G, Rosato R, Villois P, Appendino G, Ghigo E, Grassi G. Cancer mortality reduction and metformin: a retrospective cohort study in type 2 diabetic patients. Diabetes Obes Metab 2012; 14:23-9. [PMID: 21812892 DOI: 10.1111/j.1463-1326.2011.01480.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Few studies suggest that metformin decreases cancer mortality in type-2 diabetic patients (T2DP). We explored the association between the type and duration of antidiabetic therapies and cancer and other-than-cancer mortality in a T2DP cohort, taking into account the competing risks between different causes of death and multiple potential confounding effects. The mortality rates were compared with the general population from the same area. METHODS In 1995, all T2DP (n = 3685) at our diabetes clinic in Turin (∼12% of all T2DP in the city), without cancer at baseline, were identified. Vital status was assessed after a mean 4.5-year follow-up. RESULTS Metformin users had greater adiposity, while insulin users had more co-morbidities. All-cause- and cancer-related deaths occurred in: 9.2 and 1.6% of metformin users, 13.1 and 3.0% of sulfonylureas users and 26.8 and 4.8% of insulin users, respectively. In a Cox regression model for competing risks, adjusted for propensity score, metformin users showed a lower cancer mortality risk [hazard ratio (HR) = 0.56; 95% confidence interval (CI) 0.34-0.94], while insulin was positively associated with other-than-cancer mortality (HR = 1.56; 95%CI 1.22-1.99). Each 5-year metformin exposure was associated with a reduction in cancer death by 0.73, whereas every 5-year insulin exposure was associated with 1.25-fold increase in other-than-cancer death. Standardized mortality ratios for cancer and other-than-cancer mortality in metformin users were 43.6 (95%CI 25.8-69.0) and 99.1 (95%CI 79.3-122.5), respectively, in comparison with the general population. CONCLUSIONS Metformin users showed a lower risk of cancer-related mortality than not users or patients on diet only; this may represent another reason to choose metformin as a first-line therapy in T2DP.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Torino, Turin, Italy.
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Gregori D, Petrinco M, Bo S, Desideri A, Merletti F, Pagano E. Regression models for analyzing costs and their determinants in health care: an introductory review. Int J Qual Health Care 2011; 23:331-41. [PMID: 21504959 DOI: 10.1093/intqhc/mzr010] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This article aims to describe the various approaches in multivariable modelling of healthcare costs data and to synthesize the respective criticisms as proposed in the literature. METHODS We present regression methods suitable for the analysis of healthcare costs and then apply them to an experimental setting in cardiovascular treatment (COSTAMI study) and an observational setting in diabetes hospital care. RESULTS We show how methods can produce different results depending on the degree of matching between the underlying assumptions of each method and the specific characteristics of the healthcare problem. CONCLUSIONS The matching of healthcare cost models to the analytic objectives and characteristics of the data available to a study requires caution. The study results and interpretation can be heavily dependent on the choice of model with a real risk of spurious results and conclusions.
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Affiliation(s)
- Dario Gregori
- Department of Environmental Medicine and Public Health, Via Loredan 18, 35121 Padova, Italy.
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Predictors of preventable hospitalization in chronic disease: priorities for change. J Public Health Policy 2010; 31:150-63. [PMID: 20535098 DOI: 10.1057/jphp.2010.3] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Research in the area of preventable hospitalization, hospital admissions that could otherwise be avoided, provides little guidance in terms of priority areas for change. This synthesis of multiple electronic databases searched systematically for studies related to preventable hospitalization identifies six priority areas for future action in three broad conceptual areas: person priorities (symptom management and supportive relationships), programme priorities (self-management supports and service delivery), and place priorities (local infrastructure and socio-economic opportunities). Attention to these priorities could help reduce preventable hospitalization while simultaneously improving health access and quality of care.
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Li CL, Chang HY, Lu JR. Health-related quality of life predicts hospital admission within 1 year in people with diabetes: a nationwide study from Taiwan. Diabet Med 2009; 26:1055-62. [PMID: 19900239 DOI: 10.1111/j.1464-5491.2009.02818.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate whether health-related quality of life (HRQOL) predicts hospital admission in a nationally representative sample of adults with diabetes. METHODS We conducted a prospective study on persons aged > or = 18 years with self-reported physician-diagnosed diabetes (n = 797) who participated in the National Health Interview Survey in Taiwan, 2001. Of these potential participants, 674 provided consent for data linkage and were successfully linked to the National Health Insurance claims data. We analysed the associations between the Short Form 36 (SF-36) subscales and summaries and the occurrence of hospital admission for any cause during 2002. RESULTS Approximately 23% of participants with diabetes had at least one hospital admission during 2002. After adjusting for demographic characteristics, co-morbidities and diabetics-related attributes, those who had been admitted to hospital had significantly poorer mean scores on each of the physical dimensions, physical components summary (PCS) and social functioning domain of the SF-36 at baseline. In logistic regression models, poorer scores on the PCS [odds ratio (OR) = 1.80; 95% confidence interval (CI) = (1.14-2.86)], duration of diabetes > or = 10 years [OR = 2.10; 95% CI = (1.14-3.89)] and the presence of heart disease [OR = 1.63; 95% CI = (1.01-2.63)] were significantly associated with an increased risk of hospital admission. CONCLUSION In people with diabetes, poorer scores on the PCS of the SF-36 at baseline may provide additional information for assessment of hospital admission risk, independent of other measures of health outcomes.
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Affiliation(s)
- C L Li
- Department of Health Care Management, Chang Gung University, Tao-Yuan 333, Taiwan
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Using Data Mining Techniques in Monitoring Diabetes Care. The Simpler the Better? J Med Syst 2009; 35:277-81. [DOI: 10.1007/s10916-009-9363-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022]
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Kim S, Boye KS. Excessive hospitalizations and its associated economic burden among people with diabetes in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:267-272. [PMID: 20667061 DOI: 10.1111/j.1524-4733.2008.00443.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES We conducted this study to estimate the excessive hospital admission among people with diabetes and the associated economic burden in the USA. METHODS The study was based on the 2005 Nationwide Inpatient Sample (NIS), a nationally representative probability sample conducted annually by the Agency of Health Research and Quality. Nearly 8 million records were sampled from over 1000 community hospitals in the 2005 NIS. RESULTS Excluding childbirth-related admissions, the estimated US hospitalizations numbered approximately 30.8 million; individuals with diabetes accounted for over 6.4 million (20.9%) of these admissions. For every 1000 individuals without diabetes, with type 1 diabetes, and with type 2 diabetes, the numbers of hospitalizations were 89, 418, and 303, respectively. The rates of hospitalization increased greatly by the presence of diabetes for all age groups and sex. During 2005, the national bill of hospital charges and costs for individuals with diabetes exceeded US$171 billion and US$90 billion, respectively. If the prevalence of diabetes increases to 7.5% from 7.0%, the total number of hospitalizations made by individuals with diabetes will be 7.5 million in 2015. CONCLUSIONS Although approximately 7% of the population had diabetes in the USA, nearly 20.9% of hospitalizations were made by individuals with this condition. Due to the excessive hospitalizations incurred by patients with diabetes, a small increase in the number of people with diabetes will amplify the number of hospitalizations. Health-care communities should anticipate this possible increased demand of hospitalizations and the associated economic burden.
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Affiliation(s)
- Sunny Kim
- School of Public Health, Florida International University, Miami, FL 33199, USA.
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Gregori D, Petrinco M, Barbati G, Bo S, Desideri A, Zanetti R, Merletti F, Pagano E. Extreme regression models for characterizing high-cost patients. J Eval Clin Pract 2009; 15:164-71. [PMID: 19239597 DOI: 10.1111/j.1365-2753.2008.00976.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Healthcare cost distribution generally presents a high level of skewness, with a relatively small number of subjects accounting for a large portion of healthcare expenditures. Information on factors that predict high expenditures is of interest in healthcare planning. The aim of this paper was to inspect the behaviour of extreme regression (ER) models. METHODS We performed a simple simulation study, based on the LogNormal distribution, to assess the performance of ER in the special cases of heterogeneity and strong asymmetry of the cost variable. We then discussed the application of ER models to the analysis of three data sets of diabetes, lung cancer and myocardial infarction patients. RESULTS The ER showed to be able to cope fairly well with skewed distribution but under the condition that all observations have strictly positive costs. CONCLUSION The main advantage of the ER model is to unify these approaches in a unique framework, where the estimation of the cut-offs and the production of the prediction rules are performed simultaneously for a continuous response variable. The final model can thus be analysed at any desiderate quantile of the cost distribution, avoiding the need of pre-specifying any cut-off.
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Affiliation(s)
- Dario Gregori
- Department of Public Health and Microbiology, University of Turin, Turin, Italy.
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Pagano E, Bo S, Petrinco M, Rosato R, Merletti F, Gregori D. Factors affecting hospitalization costs in Type 2 diabetic patients. J Diabetes Complications 2009; 23:1-6. [PMID: 18413159 DOI: 10.1016/j.jdiacomp.2007.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 09/24/2007] [Accepted: 09/24/2007] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate Type 2 diabetes hospitalization costs and their determinants by applying a proper methodological approach, taking into account the presence of several observations with zero costs. METHODS A cohort study using per-patient hospital discharge abstracts in a period of 4.5 years of follow-up (from 1/1/1996 to 30/6/2000). Potential cost predictors were age, sex, body max index, hypertension, diabetes duration, hemoglobin A1c levels, insulin treatment, retinopathy, coronary artery disease, peripheral artery disease, nephropathy, death and presence of comorbidity (cancer, chronic liver disease, chronic obstructive pulmonary disease, and psychiatric disease). Among risk factors, total cholesterol, HDL cholesterol and smoking were considered. A two-part model has been adopted in order to take into account the presence of patients with zero hospital costs: the probability of any hospitalization has been modeled via a standard logit generalized linear model (GLM); the actual level of total costs has been modeled via a GLM, with a gamma cost distribution and a LOG link function. RESULTS In 4.5 years the median total cost per hospitalized person was $4404 (mean $8180). In line with existing evidence, diabetes complications showed a high impact on average costs. In particular, peripheral and coronary artery diseases determined more than $1000 increase in the median costs. Chronic comorbidity were responsible for the highest incremental hospitalization costs ($1771). CONCLUSIONS Hospitalization costs were significantly increased by the presence of diabetes complications and chronic conditions. The adoption of a two-part model has allowed to obtain estimates not neglecting the effect of covariates on the probability of having no hospital care.
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Affiliation(s)
- Eva Pagano
- Unit of Cancer Epidemiology, Ospedale S. Giovanni Battista, CPO-Piemonte and University of Turin, Torino, Italy.
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Tomlin AM, Dovey SM, Tilyard MW. Risk factors for hospitalization due to diabetes complications. Diabetes Res Clin Pract 2008; 80:244-52. [PMID: 18243393 DOI: 10.1016/j.diabres.2007.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 12/08/2007] [Indexed: 01/19/2023]
Abstract
AIM To determine risk factors monitored in primary care that were significantly associated with diabetes complications requiring hospitalization. METHODS We examined clinical and demographic data for 1080 Type 1 and 11,283 Type 2 New Zealand diabetes patients attending a free primary care diabetes examination between 2000 and 2002. Hospital admissions data for the 2 years following the index examination were linked for each patient using a unique National Health Index code. Logistic regression was used to determine odds ratios for the likelihood of developing diabetic complications adjusted for each variable. RESULTS In the Type 1 cohort, 222 patients (20.6%) were hospitalized for diabetes complications and 1948 patients (17.3%) in the Type 2 cohort. In both cohorts, patients admitted with diabetes complications had significantly higher mean glycosylated haemoglobin (HbA1c) (p<0.001) and triglyceride levels (p<0.001), urine albumin:creatinine ratios (p<0.001) and duration of diabetes (p<0.01 Type 1: p<0.001 Type 2) than patients not admitted. In Type 2 patients, age, obesity, HbA1c, urine albumin:creatinine ratios, HDL levels and treatment with insulin or oral medication were all associated with increased odds of admission. CONCLUSIONS Although it is well known that HbA1c is a significant predictor of diabetes complications, this study shows that urine albumin:creatinine ratio, body mass index, triglycerides and high density lipoproteins are also independent predictors of hospitalization for diabetes complications. Attention to all these factors in the primary care setting is indicated if the burden of diabetes complications to hospital services is to be minimized.
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Affiliation(s)
- Andrew M Tomlin
- Royal New Zealand College of General Practitioners' Research Unit, Department of General Practice, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, New Zealand
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Baldi I, Maule M, Bigi R, Cortigiani L, Bo S, Gregori D. Some notes on parametric link functions in clinical research. Stat Methods Med Res 2008; 18:131-44. [DOI: 10.1177/0962280208088624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ileana Baldi
- Unit of Cancer Epidemiology, CeRMS and CPO Piemonte, University of Torino
| | - Milena Maule
- Unit of Cancer Epidemiology, CeRMS and CPO Piemonte, University of Torino
| | - Riccardo Bigi
- Cardiology, Department of Medicine and Surgery, University School of Medicine and Centro Diagnostico Italiano, Milan, Italy
| | | | - Simona Bo
- Department of Internal Medicine, University of Torino, Italy
| | - Dario Gregori
- Department of Public Health and Microbiology, University of Torino, Italy,
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Rosa RDS, Schmidt MI, Duncan BB, Souza MDFMD, Lima AKD, Moura LD. Internações por Diabetes Mellitus como diagnóstico principal na Rede Pública do Brasil, 1999-2001. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2007. [DOI: 10.1590/s1415-790x2007000400004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever no âmbito nacional e por faixa etária, sexo e região as 327.800 hospitalizações por diabetes mellitus (DM) da rede pública do Brasil, entre 1999-2001. MÉTODOS: Foram utilizados dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) referentes ao DM (diagnóstico principal CID-10 E10-E14 combinado com procedimento realizado) e indicadores anuais de hospitalizações/10(4)hab. e óbitos hospitalares/10(6)hab. (ajustados pelo método direto por idade), letalidade, médias de permanência e gastos por internação e por 10(4)hab. em US$, e regressão logística múltipla para desfecho óbito. RESULTADOS: Houve mais hospitalizações anuais do sexo feminino (7,5/10(4)hab. [intervalo de confiança de 95%: 7,4-7,6] vs. masculino (5,2/10(4)hab. [5,2-5,3]), mais óbitos hospitalares anuais de mulheres (38,1/10(6)hab. [36,8-39,3] vs. 30,7 [29,5-32,0]), porém maior letalidade no sexo masculino (5,9 vs. 5,0%) em todas as regiões. Observou-se incremento das hospitalizações com a idade, mais acentuado para mulheres. Não houve diferença na permanência das internações com óbito (6,5 dias [6,3-6,6]) ou sem (6,4 [6,3-6,6]), apesar do gasto por internação superior (US$ 275,27 [268,37-282,16] vs. 143,45 [136,56-150,35]). O gasto anual/10(4)hab. equivaleu a US$ 969,09. A razão de chances de óbito hospitalar aumentou com a idade, foi maior para homens (1,21 [1,17-1,24]) e 2 vezes maior para habitantes das regiões Nordeste e Sudeste comparados aos da região Sul. Os gastos anuais/10(4)hab. foram 50-100% maiores nas regiões mais desenvolvidas. CONCLUSÕES: O volume e a desigualdade nos gastos enfatizam a necessidade de cobertura mais adequada da população, evitando as hospitalizações e suas complicações.
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