Emergency attendance for acute hyper- and hypoglycaemia in the adult diabetic population of the metropolitan area of Milan: quantifying the phenomenon and studying its predictors

Abstract

Background: We quantified, among diabetic adults, the frequency, costs, and factors associated with visits to the emergency department (EDs) and subsequent hospitalizations for acute hypoglycaemic and hyperglycaemic events. Methods: We included adults with diabetes residing in the Milan Agency for Health Protection between 2015 and 2017. From healthcare databases, we identified demographic variables, comorbidities, type of treatment, insulin treatment duration, previous ED attendances for acute glycaemic events, and two indicators of glycaemic monitoring. Using a validated ICD-9-CM coding algorithm, we identified all ED attendances for acute glycaemic events from the ED database and calculated their incidence. We computed the direct costs from health databases and presented them as average annual mean costs for those having had at least an ED attendance. The analysis of the association between the number of ED attendances and potential determinants was performed using zeroinflated negative binomial regression models. These two-part models concomitantly estimate two sets of parameters: the odds-ratios (ORs) of having no attendances and the incidence rate ratios (IRRs) of attendance. Results: The cohort included 168,285 subjects, 70% of subjects were older than 64 years, 56% were males, and 26% were treated with insulin. The incidence of acute glycaemic events for those attending the ED was 7.0 per 1000 patient-years, followed by hospitalization 26.0% of the time. The total annual direct cost for ED attendances due to acute glycaemic events was 174,000 €. Type of antidiabetic treatment had the strongest association with ED attendances for hypoglycaemia. Patients assuming insulin only had a lower probability of having no attendances (OR compared to those who assumed non-insulin antidiabetic drugs =0.01, 95% CI = 0.00-0.02). These patients also had the highest rate of hyperglycaemic episodes (IRR = 7.7, 95% CI = 5.1-11.7 for insulin only vs. non-insulin antidiabetic drugs). Subjects having had a previous episode of the same type leading to an ED visit had a higher rate of subsequent attendances (IRR for hypoglycaemia = 5.3, 95% CI = 3.9-7.3 and IRR for hyperglycaemia = 3.7, 95% CI = 1.3-10.2).

Characteristics of patients with emergency attendance for severe hypoglycemia and hyperglycemia in a general hospital in Japan

“…From 2015 to 2019, 0.15% of the ED visits by ambulance in our hospital were due to hyperglycemia, which was 30% of the total incidence of hypoglycemia and was 41% of hypoglycemic events in DM patients. Although there has been no report in which the incidences of hypoglycemia and hyperglycemia are compared at the same time in Japan, fewer ED visits due to acute hyperglycemia than due to hypoglycemia were similar to the results of previous studies by Wang et al (42%–62% in the US) [11] and by Andreano et al (30% in Italy) [18] …”

“…failure are associated with ED attendance for hyperglycemia. [18] In the present study, however, none of the 26 patients visited multiple times due to hyperglycemia during the 5-year period. Since only a few patients were being treated in our hospital, it was difficult to investigate renal function before the ED visits.…”

“…Although there has been no report in which the incidences of hypoglycemia and hyperglycemia are compared at the same time in Japan, fewer ED visits due to acute hyperglycemia than due to hypoglycemia were similar to the results of previous studies by Wang et al (42%–62% in the US) [ 11 ] and by Andreano et al (30% in Italy). [ 18 ]…”

“…Although there has been no report in which the incidences of hypoglycemia and hyperglycemia are compared at the same time in Japan, fewer ED visits due to acute hyperglycemia than due to hypoglycemia were similar to the results of previous studies by Wang et al (42%-62% in the US) [11] and by Andreano et al (30% in Italy). [18] In this study, we compared the clinical characteristics, including hemodynamics, of patients with acute severe hypoglycemia and those with acute severe hyperglycemia (Table 1). Systolic BP was lower and pulse rate was higher in patients with hyperglycemia than in patients with hypoglycemia.…”

Population-based incidence and prevalence of inflammatory bowel diseases in Milan (Northern Italy), and estimates for Italy

“…This is a real-world study carried out in a northern Italian area where the health services are highly digitized and belong to a unique informatics system. Such administrative records have been widely used to evaluate a broad range of diseases [18][19][20][21][22], including the economic burden of IBDs [23]. The AHP provides care to about three 3 500 000 inhabitants.…”