Risk Factors of Recurrent Hospital Admission for Young Adults Presenting with Hyperglycemic Emergencies at an Inner City Hospital Open Access

Findley, Mary Katherine (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/st74cq459?locale=en



Background:  Over 150,000 hyperglycemic emergencies occur in the United States each year.  Hyperglycemic emergencies are associated with morbidity, mortality, and increased healthcare costs.  Young adults under the age of 35 have disproportionally high rates of hyperglycemic emergency hospital admissions.  The purpose of this study was to characterize the young adult admitted to an inner-city hospital for a hyperglycemic emergency and identify risk factors for recurrent hyperglycemic emergencies.

Methods:  Electronic health records were used to extract data from 273 young adult patients (18-35 years) admitted to an inner city hospital over a five-year period.  Independent t-tests, Chi-Square tests, and ANOVA were used to explore differences in diabetes type, glycemic control, and recurrent admissions.  Univariate binomial logistic regression was used to calculate unadjusted odds ratios and multivariable logistic regression was used to model risk factors associated with hyperglycemic emergencies.

Results:  Patients were characterized as individuals in their mid-twenties, Black and non-Hispanic, with limited access to care, Type 1 Diabetes, poor glycemic control, and a high rate of chronic diabetes complications and psychiatric co-morbidities.   Multiple hyperglycemic emergency admissions occurred in 43.6% of the sample.  Risk factors significantly associated with recurrent hospitalization compared to a single admission  included non-Hispanic ethnicity (98.2% vs. 91.6%, p=0.05), race (Black 90.8% vs 77.9%, p=0.017), lower household income ($39,048±14,421 vs $44,107±15,633, p=0.007), high utilization of health care services (emergency department 70.6% vs 22.1%, p<0.05; and hospitalization 68.9% vs 13.6%, p<0.05),  Type 1 Diabetes (82.4% vs 66.2%, p=0.003), lower age at diagnosis (16.95±7.40 vs 19.41±8.51, p=0.039), lower BMI (25.96±8.07 vs 29.17±9.20, p=0.005), presence of chronic diabetes complications (53.8% vs 37.7%, p=0.01), and psychiatric co-morbidities (any mental health history 58.0% vs 25.0%, p<0.001; depression: 26.9% vs 5.8%, p<0.001; substance use 26.9% vs 16.9%, p=0.02).  


Conclusion:  There are two significant gaps in young adult diabetes care: young adult diabetes primary care and the integration of mental healthcare into primary diabetes care.  Developing interventions to address gaps could have a high upfront cost, but if the intervention prevented hyperglycemic emergencies and recurrent admissions these programs could lead to decreased morbidity, mortality, and diabetes associated healthcare costs.

Table of Contents

  Table of Contents

Specific Aims 1

Background and Significance 3

Diabetes 3

Pathophysiology 3

Diagnosis 4

Management 5

Glycemic Control 6

Chronic Complications and Comorbidities 6

Acute Complications 9

Hyperglycemic Emergencies 9

Diabetic Ketoacidosis 10

Hyperosmolar Hyperglycemic State 11

Recurrent Hyperglycemic Emergencies 11

Young Adults 12

Disparities in Care 13

Theoretical Model 14

Demographic Factors 16

Access to Care 17

Diabetes and Hyperglycemic emergency Characteristics 17

Chronic Complications and Co-morbidities 18

Study Aims 18

Innovation 19

Approach 19

Data Collection 20

Statistical Analysis 24

Limitations 27

Paper 1:  Hospital Admissions for Hyperglycemic Emergencies in Young Adults at an Inner-City Hospital 29

Abstract 30

Introduction 31

Methods 34

Population and data sources 34

Data collection 35

Data Analysis 39

Results 40

Discussion 42

Paper 2:  Risk Factors Associated with Recurrent Hospital Admissions for Hyperglycemic Emergencies in an Inner City Young Adult Population 46

Abstract 47

Introduction 48

Methods 51

Population and data sources 51

Data collection 51

Data Analysis 52

Results 53

Discussion 57

Paper 3:  Factors Associated with High Rates of Hospital Readmission and Frequent Hyperglycemic Emergencies in an Inner City Young Adult Population 62

Abstract 63

Introduction 64

Methods 66

Population and data sources 66

Data collection 67

Data Analysis 68

Results 69

Discussion 72

Integrative Summary 77

References 82

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