Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems.
Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems.
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DOI：
10.1136/bmjdrc-2021-002153
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发表时间：
2021-12
影响因子：
4.1
通讯作者：
Yeh HC
中科院分区：
文献类型：
--
作者：
Pilla SJ;Kraschnewski JL;Lehman EB;Kong L;Francis E;Poger JM;Bryce CL;Maruthur NM;Yeh HC
低血糖是糖尿病治疗最常见的严重不良反应，也是药物相关住院的主要原因。本研究的目的是使用来自六个学术卫生系统的电子健康记录数据，确定2型糖尿病患者低血糖医院利用的趋势和预测因素。这项回顾性开放队列研究纳入了549041名2型糖尿病成人，他们在2009年至2019年期间接受了所纳入卫生系统的定期护理。主要结局是2009年至2014年期间低血糖医院利用的年事件率：使用经验证的国际疾病分类第九版（ICD-9）算法确定的急诊科访视、观察访视或低血糖住院。在2015年过渡到ICD-10后，我们使用了两个ICD-10代码集（有限和扩展）用于既往研究中的低血糖医院使用。我们使用2014年的数据进行多变量logistic回归分析，确定了低血糖医院利用率的独立预测因素。从2009年至2014年，低血糖医院利用的年发生率从2.7起事件/1000例患者降至1.6起事件/1000例患者（p趋势=0.023）。从2016年到2019年，分别使用有限和扩展ICD-10代码集，年事件发生率稳定在5.6至6.6或6.3至7.3之间。2014年，低血糖医院利用率最高的独立风险因素是慢性肾脏疾病（OR 2.86，95% CI 2.33 - 3.57），年龄18-39岁（OR 2.43 vs 40-64岁，95% CI 1.78 - 3.31）和胰岛素使用（OR 2.13 vs无糖尿病药物，95% CI 1.67 - 2.73）。低血糖医院利用率从2009年到2014年有所下降，并且因临床风险因素而变化很大，例如年轻人，胰岛素使用者和慢性肾脏疾病患者的风险特别高。需要使用ICD-10代码来验证低血糖确定，与ICD-9相比，ICD-10代码检测到的事件数量要多得多。
Hypoglycemia is the most common serious adverse effect of diabetes treatment and a major cause of medication-related hospitalization. This study aimed to identify trends and predictors of hospital utilization for hypoglycemia among patients with type 2 diabetes using electronic health record data pooled from six academic health systems. This retrospective open cohort study included 549 041 adults with type 2 diabetes receiving regular care from the included health systems between 2009 and 2019. The primary outcome was the yearly event rate for hypoglycemia hospital utilization: emergency department visits, observation visits, or inpatient admissions for hypoglycemia identified using a validated International Classification of Diseases Ninth Revision (ICD-9) algorithm from 2009 to 2014. After the transition to ICD-10 in 2015, we used two ICD-10 code sets (limited and expanded) for hypoglycemia hospital utilization from prior studies. We identified independent predictors of hypoglycemia hospital utilization using multivariable logistic regression analysis with data from 2014. Yearly rates of hypoglycemia hospital utilization decreased from 2.7 to 1.6 events per 1000 patients from 2009 to 2014 (p-trend=0.023). From 2016 to 2019, yearly event rates were stable ranging from 5.6 to 6.6, or 6.3 to 7.3, using the limited and expanded ICD-10 code sets, respectively. In 2014, the strongest independent risk factors for hypoglycemia hospital utilization were chronic kidney disease (OR 2.86, 95% CI 2.33 to 3.57), ages 18–39 years (OR 2.43 vs age 40–64 years, 95% CI 1.78 to 3.31), and insulin use (OR 2.13 vs no diabetes medications, 95% CI 1.67 to 2.73). Rates of hypoglycemia hospital utilization decreased from 2009 to 2014 and varied considerably by clinical risk factors such that younger adults, insulin users, and those with chronic kidney disease were at especially high risk. There is a need to validate hypoglycemia ascertainment using ICD-10 codes, which detect a substantially higher number of events compared with ICD-9.
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影响因子：
5.8
作者：
Lash, Robert W.;Lucas, Deborah O.;Illes, Judit
通讯作者：
Illes, Judit
影响因子：
39.2
作者：
Conlin, Paul R.;Colburn, Jeffrey;Pogach, Leonard
通讯作者：
Pogach, Leonard
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.
DOI：
10.1017/s1742058x11000130
发表时间：
2011-04
期刊：
Du Bois review : social science research on race
影响因子：
--
作者：
Gee GC;Ford CL
通讯作者：
Ford CL