How do individuals with diabetes use the accident and emergency department?

Abstract

Objective-To determine whether the frequency and pattern of use of the accident and emergency (A&E) department by individuals with diabetes is different from that of the general population. Methods-A historical cohort of 696 individuals with diabetes from six randomly selected general practices and a nondiabetic comparison cohort matched on age, sex, and general practice were identified. The use ofan urban A&E department by the two cohorts was compared for number ofvisits between 1984 and 1996 for injuries, diabetes related and non-diabetes related illness, proportion referred by a general practitioner, proportion arriving by ambulance, and proportion admitted. Results-More visits were made by the diabetic cohort (1002 v 706, P = 0.0001); 121 visits were directly related to diabetes, including 52 for hypoglycaemia. The diabetic cohort also had more visits for medical illness unrelated to diabetes (357 v 231, P = 0.0001). The number ofvisits for injuries was similar (524 v 475, P = 0.3). Individuals with diabetes who attended A&E were not significantly more likely to be referred by a general practitioner (14% v 16%) or admitted (20% v 17%). Conclusions-Individuals with diabetes made more frequent visits than the general population to the A&E department. Since there was no excess of visits for injuries and the proportion requiring admission was similar, the hypothesis that they have a different threshold for attending is not supported.

Observational research methods. Research design II: cohort, cross sectional, and case-control studies

“…4 A recent example of a prospective cohort study by Davey Smith et al was published in the BMJ 5 and a retrospective cohort design was used to assess the use of A&E departments by people with diabetes. 6 …”

“…In this way it was found in 1983 that of 1000 patients with AIDS, 727 were homosexual or bisexual men and 236 were intrvenous drug abusers. 6 The conclusion that individuals in these two groups had a higher relative risk was inescapable. The natural history of HIV infection was then studied using cohort studies and efficacy of treatments via case controlled studies and randomised clinical trials.…”

Understanding the use of emergency department and urgent care services by diabetic patients of a Family Medicine Health Team: a retrospective observational study

“…Furthermore, CTAS scores among all three groups in this study were similar, suggesting that diabetic patients on average, may not necessarily use the ED/UC for more urgent/life-threatening complaints. This is not surprising given that Goyder et al (1997) already concluded that even though diabetic patients make more trips to the emergency department in the United Kingdom, the proportion actually requiring admission was similar to that of non-diabetic patients. As such, the results here are meant to reinforce the idea that there are other reasons diabetic patients visit the ED/UC, often unrelated to emergencies attributed to the underlying disease itself.…”

Using Structural Equation Modelling in Routine Clinical Data on Diabetes and Depression: Observational Cohort Study

“…As the purpose of this research was to test the role of mental health service use on A&E use in patients diagnosed with type 2 diabetes, we constructed a model of latent variables that reflected existing knowledge on this subject ( Figure 1 ). Within this model, for example, we recreated the links observed between depression and poor diabetes control [ 11 ] and that the comorbidity of the two conditions increases A&E attendance [ 13 ]. We also included latent variables representing mental health comorbidity and clinical risk factors for diabetes that may confound the relationship between diabetes care, depression, and A&E admission.…”

“…Depression has been shown to occur approximately twice as frequently in type 2 diabetes than would be predicted by chance alone [ 10 ], and is associated with increased diabetic complications and poor diabetic control [ 11 ]. Patients with comorbid depression and type 2 diabetes have been shown to have increased health care utilization [ 12 ]; for example, they are more likely to present at A&E departments [ 13 ] and have increased health care costs (up to 70%) compared to patients with type 2 diabetes without depression [ 14 ]. This is particularly marked in those with poorly controlled diabetes [ 15 ].…”