Hospital admissions for hyperglycemic emergencies in young adults at an inner-city hospital
There is limited information characterizing young adults (18–35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations bas...
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Published in | Diabetes research and clinical practice Vol. 157; p. 107869 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.11.2019
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Abstract | There is limited information characterizing young adults (18–35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control.
We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%).
Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance.
YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions. |
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AbstractList | There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control.
We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%).
Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance.
YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions. AIMSThere is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control. METHODSWe conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%). RESULTSMean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance. CONCLUSIONSYA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions. |
ArticleNumber | 107869 |
Author | Wolf, Rachel A Cha, EunSeok Findley, MK Paul, Sudeshna Spezia Faulkner, Melissa Mehta, Komal Alexopoulos, Anastasia-Stefania Khan, Farah Alfa, David A Ali, Mohammed K Haw, J. Sonya Markley Webster, Sara |
AuthorAffiliation | e Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA a Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA b School of Medicine, Emory University, Atlanta, GA g Rollins School of Public Health, Emory University, Atlanta GA f Division of Endocrinology, Duke University Medical Center, Durham, NC c School of Nursing, Georgia State University, Atlanta, GA d Chungnam National University, College of Nursing, Daejeon, South Korea |
AuthorAffiliation_xml | – name: a Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA – name: d Chungnam National University, College of Nursing, Daejeon, South Korea – name: e Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA – name: b School of Medicine, Emory University, Atlanta, GA – name: g Rollins School of Public Health, Emory University, Atlanta GA – name: f Division of Endocrinology, Duke University Medical Center, Durham, NC – name: c School of Nursing, Georgia State University, Atlanta, GA |
Author_xml | – sequence: 1 givenname: Rachel A surname: Wolf fullname: Wolf, Rachel A email: rwolf@emory.edu organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States – sequence: 2 givenname: J. Sonya surname: Haw fullname: Haw, J. Sonya organization: School of Medicine, Emory University, Atlanta, GA, United States – sequence: 3 givenname: Sudeshna surname: Paul fullname: Paul, Sudeshna organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States – sequence: 4 givenname: Melissa surname: Spezia Faulkner fullname: Spezia Faulkner, Melissa organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States – sequence: 5 givenname: EunSeok surname: Cha fullname: Cha, EunSeok organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States – sequence: 6 givenname: MK surname: Findley fullname: Findley, MK organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States – sequence: 7 givenname: Farah surname: Khan fullname: Khan, Farah organization: School of Medicine, Emory University, Atlanta, GA, United States – sequence: 8 givenname: Sara surname: Markley Webster fullname: Markley Webster, Sara organization: School of Medicine, Emory University, Atlanta, GA, United States – sequence: 9 givenname: Anastasia-Stefania surname: Alexopoulos fullname: Alexopoulos, Anastasia-Stefania organization: Division of Endocrinology, Duke University Medical Center, Durham, NC, United States – sequence: 10 givenname: Komal surname: Mehta fullname: Mehta, Komal organization: School of Medicine, Emory University, Atlanta, GA, United States – sequence: 11 givenname: David A surname: Alfa fullname: Alfa, David A organization: School of Medicine, Emory University, Atlanta, GA, United States – sequence: 12 givenname: Mohammed K surname: Ali fullname: Ali, Mohammed K organization: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States |
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Keywords | Inpatient hospitalization Glycemic control Young adults Vulnerable populations Hyperglycemic emergency |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 RW and MKF prepared and edited the manuscript. MKF, FK, SMW, ASA, DA assisted with data extraction and reviewed and edited the manuscript. SP guided the data analyses. MA, EC, MF, JSH participated in the development of the initial study design, methods, interpretation and reviewed and edited the manuscript. JSH is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the analyses performed. Author contributions |
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Snippet | There is limited information characterizing young adults (18–35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study... There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study... AIMSThere is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The... |
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SubjectTerms | Adolescent Adult Diabetes Complications - complications Diagnostic Tests, Routine - methods Emergencies Emergency Service, Hospital Female Glycemic control Hospitalization Hospitals, Urban Humans Hyperglycemic emergency Inpatient hospitalization Male Retrospective Studies Vulnerable populations Young Adult Young adults |
Title | Hospital admissions for hyperglycemic emergencies in young adults at an inner-city hospital |
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