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)
Abstract
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
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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