Association of Cumulative Multimorbidity, Glycemic Control, and Medication Use With Hypoglycemia-Related Emergency Department Visits and Hospitalizations Among Adults With Diabetes
| العنوان: | Association of Cumulative Multimorbidity, Glycemic Control, and Medication Use With Hypoglycemia-Related Emergency Department Visits and Hospitalizations Among Adults With Diabetes |
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| المؤلفون: | Holly K. Van Houten, Rozalina G. McCoy, Kasia J. Lipska, Nilay Shah |
| المصدر: | JAMA Network Open |
| بيانات النشر: | American Medical Association (AMA), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Adult, Male, Pediatrics, medicine.medical_specialty, 030204 cardiovascular system & hematology, Hypoglycemia, Rate ratio, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, medicine, Humans, Hypoglycemic Agents, 030212 general & internal medicine, Original Investigation, Aged, Retrospective Studies, Glycated Hemoglobin, Type 1 diabetes, business.industry, Research, Age Factors, Multimorbidity, Retrospective cohort study, General Medicine, Emergency department, Middle Aged, medicine.disease, United States, 3. Good health, Hospitalization, Online Only, Diabetes and Endocrinology, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, chemistry, Cohort, Female, Glycated hemoglobin, Emergency Service, Hospital, business, Cohort study |
| الوصف: | This cohort study examines the associations of age, cumulative multimorbidity, glycated hemoglobin level, and use of glucose level–lowering medication with hypoglycemia-related emergency department visits and hospitalizations among adults with diabetes. Key Points Question Among adults with diabetes, what is the association of multimorbidity with the risk of severe hypoglycemia in the context of other frequently encountered hypoglycemia risk factors, such as age, diabetes type, prior hypoglycemia, glycemic control, and high-risk medication use? Findings In this cohort study of 201 705 adults with diabetes in the United States, most individuals had additional chronic health conditions. Cumulative multimorbidity was associated with hypoglycemia-related emergency department visits and hospitalizations independent of other factors. Meaning Clinicians may want to consider a broad range of hypoglycemia risk factors, particularly cumulative multimorbidity, when developing a diabetes treatment plan and prioritize prescribing medications with a lower risk for hypoglycemia. Importance Severe hypoglycemia is a serious and potentially preventable complication of diabetes, with some of the most severe episodes requiring emergency department (ED) care or hospitalization. A variety of health conditions increase the risk of hypoglycemia. People with diabetes often have multiple comorbidities, and the association of such multimorbidity with hypoglycemia risk in the context of other risk factors is uncertain. Objective To examine the associations of age, cumulative multimorbidity, glycated hemoglobin (HbA1c) level, and use of glucose level–lowering medication with hypoglycemia-related ED visits and hospitalizations. Design, Setting, and Participants Cohort study of claims and laboratory data from OptumLabs Data Warehouse, an administrative claims database of commercially insured and Medicare Advantage beneficiaries in the United States. Participants were adults (aged ≥18 years) with diabetes who had an available HbA1c level result in 2015. Data from January 1, 2014, to December 31, 2016, were analyzed. Final analyses were conducted from December 2017 to September 2018. Main Outcomes and Measures This study calculated rates of hypoglycemia-related ED visits and hospitalizations during the year after the index HbA1c level was obtained, stratified by patient demographic characteristics, diabetes type, comorbidities (from 16 guideline-specified high-risk conditions), index HbA1c level, and glucose level–lowering medication use. The association of each variable with hypoglycemia-related ED and hospital care was examined using multivariable Poisson regression analysis overall and by diabetes type. Results The study cohort was composed of 201 705 adults with diabetes (mean [SD] age, 65.8 [12.1] years; 102 668 [50.9%] women; 118 804 [58.9%] white; mean [SD] index HbA1c level, 7.2% [1.5%]). Overall, there were 9.06 (95% CI, 8.64-9.47) hypoglycemia-related ED visits and hospitalizations per 1000 persons per year. The risk of hypoglycemia-related ED visits and hospitalizations was increased by age 75 years or older (incidence rate ratio [IRR], 1.56 [95% CI, 1.23-2.02] vs 18-44 years), black race/ethnicity (IRR, 1.30 [95% CI, 1.16-1.46] vs white race/ethnicity), lower annual household income (IRR, 0.63 [95% CI, 0.53-0.74] for ≥$100 000 vs |
| تدمد: | 2574-3805 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d2498b7a9e163fefb28bdc7d385f1288Test https://doi.org/10.1001/jamanetworkopen.2019.19099Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....d2498b7a9e163fefb28bdc7d385f1288 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 25743805 |
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