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Predictors of 30-day recurrent emergency department visits for hyperglycemia in patients with types 1 and 2 diabetes: a population-based cohort study

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Abstract

Objectives

This study’s aims were to describe the outcomes of patients with diabetes presenting with their first ED visit for hyperglycemia, and to identify predictors of recurrent ED visits for hyperglycemia.

Methods

Using linked databases, we conducted a population-based cohort study of adult and pediatric patients with types 1 and 2 diabetes presenting with a first ED visit for hyperglycemia from April 2010 to March 2020 in Ontario, Canada. We determined the proportion of patients with a recurrent ED visit for hyperglycemia within 30 days of the index visit. Using multivariable regression analysis, we examined clinical and socioeconomic predictors for recurrent visits.

Results

There were 779,632 patients with a first ED visit for hyperglycemia. Mean (SD) age was 64.3 (15.2) years; 47.7% were female. 11.0% had a recurrent visit for hyperglycemia within 30 days. Statistically significant predictors of a recurrent visit included: male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, more family physician or internist visits within the past year, being rostered to a family physician, previous ED visits in the past year, ED or hospitalization within the previous 14 days, access to homecare services, and previous hyperglycemia encounters in the past 5 years. Alcoholism and depression or anxiety were positive predictors for the 18–65 age group.

Conclusions

This population-level study identifies predictors of recurrent ED visits for hyperglycemia, including male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, higher previous healthcare system utilization (ED visits and hospitalization) for hyperglycemia, being rostered to a family physician, and access to homecare services. Knowledge of these predictors may be used to develop targeted interventions to improve patient outcomes and reduce healthcare system costs.

Abstrait

Objectifs

Les objectifs de cette étude étaient de décrire les résultats des patients diabétiques présentant leur première visite aux urgences pour hyperglycémie, et d’identifier les prédicteurs des visites récurrentes aux urgences pour hyperglycémie.

Méthodes

À l’aide de bases de données couplées, nous avons mené une étude de cohorte basée sur la population de patients adultes et pédiatriques atteints de diabète de type 1 et 2 présentant une première visite aux urgences pour l’hyperglycémie d’avril 2010 à mars 2020 en Ontario, au Canada. Nous avons déterminé la proportion de patients présentant une visite récurrente à l’urgence pour hyperglycémie dans les 30 jours suivant la visite d’index. À l’aide d’une analyse de régression multivariée, nous avons examiné les prédicteurs cliniques et socioéconomiques des visites récurrentes.

Résultats

Il y avait 779 632 patients avec une première visite à l’urgence pour hyperglycémie. L’âge moyen (ET) était de 64,3 (15,2) ans; 47,7% étaient des femmes. 11,0 % avaient une visite récurrente pour hyperglycémie dans les 30 jours. Les prédicteurs statistiquement significatifs d’une visite récurrente comprenaient le sexe masculin, le diabète de type 1, les régions comptant moins de groupes de minorités visibles et ayant moins d’études ou d’emploi, une hémoglobine A1C plus élevée, plus de visites chez un médecin de famille ou un interniste au cours de la dernière année, être inscrit auprès d’un médecin de famille, consulter le service d’urgence au cours de la dernière année, être hospitalisé au cours des 14 derniers jours, avoir accès à des services de soins à domicile et avoir été confronté à une hyperglycémie au cours des 5 dernières années. L’alcoolisme et la dépression ou l’anxiété étaient des prédicteurs positifs pour le groupe des 18-65 ans.

Conclusions

Cette étude au niveau de la population identifie des prédicteurs de visites récurrentes aux urgences pour l’hyperglycémie, y compris le sexe masculin, le diabète de type 1, les régions avec moins de groupes de minorités visibles et avec moins d’études ou d’emploi, plus d’hémoglobine A1C, l’utilisation antérieure plus élevée du système de soins de santé (visites aux urgences et hospitalisation) pour l’hyperglycémie, le fait d’être inscrit auprès d’un médecin de famille et l’accès aux services de soins à domicile. La connaissance de ces prédicteurs peut être utilisée pour élaborer des interventions ciblées afin d’améliorer les résultats pour les patients et de réduire les coûts du système de santé.

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Data availability

The data supporting the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

We thank IQVIA Solutions Canada Inc. for use of their Drug Information File, the Ontario Ministry of Health for use of the Ontario Laboratories Information System (OLIS), and the Toronto Community Health Profiles Partnership for providing access to the Ontario Marginalization Index.

Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received support from an Innovation Fund from the Academic Medical Organization of Southwestern Ontario (AMOSO) (grant no. INN21-004). JWY is supported as a Clinician Researcher by the Division of Emergency Medicine and Department of Medicine at Western University. This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario MOH Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI), Ontario Health (OH) and the Ontario MOH. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Author information

Authors and Affiliations

  1. Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Justin W. Yan

  2. Lawson Health Research Institute, London Health Sciences Centre Victoria Hospital, London, ON, Canada

    Justin W. Yan, Branka Vujcic, Kristine Van Aarsen, Tom Chen & Fardowsa Halane

  3. Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada

    Branka Vujcic, Kristine Van Aarsen, Tom Chen & Fardowsa Halane

  4. ICES Western, London Health Sciences Research Institute, London, ON, Canada

    Britney N. Le & Kristin K. Clemens

  5. Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Kristin K. Clemens

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  1. Justin W. Yan
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Contributions

JY conceived and obtained research funding. JY, BV, BL, KVA, and KC designed the study. BL acquired and analyzed the data, and all authors assisted with interpretation of the data. JY drafted the manuscript, and all authors contributed substantially to its revision.

Corresponding author

Correspondence to Justin W. Yan.

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Conflict of interest

Outside of this study, KC has received a research award sponsored in part by Astra Zeneca. She has attended conferences sponsored by Merck. She has received honoraria for delivering certified medical education from Sutherland Global Services Canada ULC, the Canadian Medical and Surgical Knowledge Translation Group and the CPD Network. There are no other conflicts of interest to declare.

Additional information

Presentations: A preliminary, abstract only version of this work was accepted for poster presentation at the Diabetes Canada annual conference, Calgary, Alberta, Canada, November 2022 (https://www.canadianjournalofdiabetes.com/article/S1499-2671(22)00299-4/fulltext) and oral presentation at the Canadian Association of Emergency Physicians annual conference, Toronto, Ontario, Canada, May 2023.

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Yan, J.W., Vujcic, B., Le, B.N. et al. Predictors of 30-day recurrent emergency department visits for hyperglycemia in patients with types 1 and 2 diabetes: a population-based cohort study. Can J Emerg Med (2024). https://doi.org/10.1007/s43678-024-00686-4

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