Trends in Emergency Department Visits and Inpatient Admissions for Hyperglycemic Crises in Adults With Diabetes in the US, 2006-2015
Trends in Emergency Department Visits and Inpatient Admissions for Hyperglycemic Crises in Adults With Diabetes in the US, 2006-2015
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DOI：
10.2337/dc19-2449
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发表时间：
2020-05-01
期刊：
影响因子：
16.2
通讯作者：
Imperatore, Giuseppina
中科院分区：
文献类型：
--
作者：
Benoit, Stephen R.;Hora, Israel;Imperatore, Giuseppina
目的报告美国急诊科（艾德）和住院患者中成人糖尿病酮症酸中毒（DKA）和高血糖高渗状态（HHS）的全国人群发病率和趋势。研究设计和方法我们分析了2006年1月1日至2015年9月30日来自全国急诊科样本和全国住院患者样本的数据，以描述DKA和HHS的艾德就诊和住院患者。我们使用国家健康访谈调查中相应年份的横断面调查数据来估计≥ 18岁确诊糖尿病的成年人数量，以计算艾德和住院患者中DKA和HHS的人群发生率。使用Joinpoint软件评估了2009年至2015年的线性趋势。结果：2014年，DKA和HHS分别发生了184，255和27，532起事件。大多数DKA事件发生在18-44岁的年轻人（61.7%）和1型糖尿病成人（70.6%）中，而HHS事件在45-64岁的中年人（47.5%）和2型糖尿病成人（88.1%）中更为突出。大约40%的高血糖事件发生在低收入人群中。总体而言，从2009年至2015年，艾德（年百分比变化[APC] 13.5%）和住院患者（APC 8.3%）的DKA事件发生率均显著增加。在HHS中观察到类似的趋势（APC在艾德中为16.5%，在住院患者中为6.3%）。所有年龄组的男女都有增加。结论：高血糖事件发生率增加的原因尚不清楚。需要更详细的数据来调查病因并确定预防策略。
OBJECTIVE To report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient settings. RESEARCH DESIGN AND METHODS We analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults >= 18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software. RESULTS In 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18-44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45-64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age-groups and in both men and women. CONCLUSIONS Causes of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies.