دورية أكاديمية
أعرض في EDS

Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020.

التفاصيل البيبلوغرافية
العنوان: Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020.
المؤلفون: McCoy RG; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota., Galindo RJ; Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia., Swarna KS; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota., Van Houten HK; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.; HealthPartners Institute Center for Chronic Care Innovation, Minneapolis, Minnesota., O'Connor PJ; HealthPartners Institute Center for Chronic Care Innovation, Minneapolis, Minnesota., Umpierrez GE; Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia., Shah ND; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.; OptumLabs, Eden Prairie, Minnesota.
المصدر: JAMA network open [JAMA Netw Open] 2021 Sep 01; Vol. 4 (9), pp. e2123471. Date of Electronic Publication: 2021 Sep 01.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Diabetes Mellitus, Type 1/*drug therapy , Diabetes Mellitus, Type 2/*drug therapy , Hyperglycemia/*epidemiology , Insulin, Regular, Human/*therapeutic use, Adolescent ; Adult ; Age Factors ; Cohort Studies ; Demography ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 2/complications ; Ethnicity ; Female ; Glycated Hemoglobin/metabolism ; Humans ; Hyperglycemia/ethnology ; Hyperglycemia/etiology ; Insurance Claim Review ; Male ; Middle Aged ; Poverty ; Retrospective Studies ; Risk Factors ; Social Class ; United States/epidemiology ; Young Adult
مستخلص: Importance: Hyperglycemic crises (ie, diabetic ketoacidosis [DKA] and hyperglycemic hyperosmolar state [HHS]) are life-threatening acute complications of diabetes. Efforts to prevent these events at the population level have been hindered by scarce granular data and difficulty in identifying individuals at highest risk.
Objective: To assess sociodemographic, clinical, and treatment-related factors associated with hyperglycemic crises in adults with type 1 or type 2 diabetes in the US from 2014 to 2020.
Design, Setting, and Participants: This retrospective cohort study analyzed administrative claims and laboratory results for adults (aged ≥18 years) with type 1 or type 2 diabetes from the OptumLabs Data Warehouse from January 1, 2014, through December 31, 2020.
Main Outcomes and Measures: Rates of emergency department or hospital visits with a primary diagnosis of DKA or HHS (adjusted for age, sex, race/ethnicity, and region, and for year when calculating annualized rates) were calculated separately for patients with type 1 diabetes and type 2 diabetes. The associations of sociodemographic factors (age, sex, race/ethnicity, region, and income), clinical factors (comorbidities), and treatment factors (glucose-lowering medications, hemoglobin A1c) with DKA or HHS in patients with type 1 or type 2 diabetes were assessed using negative binomial regression.
Results: Among 20 156 adults with type 1 diabetes (mean [SD] age, 46.6 [16.5] years; 51.2% male; 72.6% White race/ethnicity) and 796 382 with type 2 diabetes (mean [SD] age, 65.6 [11.8] years; 50.3% female; 54.4% White race/ethnicity), adjusted rates of hyperglycemic crises were 52.69 per 1000 person-years (95% CI, 48.26-57.12 per 1000 person-years) for type 1 diabetes and 4.04 per 1000 person-years (95% CI, 3.88-4.21 per 1000 person-years) for type 2 diabetes. In both groups, factors associated with the greatest hyperglycemic crisis risk were low income (≥$200 000 vs <$40 000: type 1 diabetes incidence risk ratio [IRR], 0.61 [95% CI, 0.46-0.81]; type 2 diabetes IRR, 0.69 [95% CI, 0.56-0.86]), Black race/ethnicity (vs White race/ethnicity: type 1 diabetes IRR, 1.33 [95% CI, 1.01-1.74]; type 2 diabetes IRR, 1.18 [95% CI, 1.09-1.27]), high hemoglobin A1c level (≥10% vs 6.5%-6.9%: type 1 diabetes IRR, 7.81 [95% CI, 5.78-10.54]; type 2 diabetes IRR, 7.06 [95% CI, 6.26-7.96]), history of hyperglycemic crises (type 1 diabetes IRR, 7.88 [95% CI, 6.06-9.99]; type 2 diabetes IRR, 17.51 [95% CI, 15.07-20.34]), severe hypoglycemia (type 1 diabetes IRR, 2.77 [95% CI, 2.15-3.56]; type 2 diabetes IRR, 4.18 [95% CI, 3.58-4.87]), depression (type 1 diabetes IRR, 1.62 [95% CI, 1.37-1.92]; type 2 diabetes IRR, 1.46 [95% CI, 1.34-1.59]), neuropathy (type 1 diabetes IRR, 1.64 [95% CI, 1.39-1.93]; type 2 diabetes IRR, 1.25 [95% CI, 1.17-1.34]), and nephropathy (type 1 diabetes IRR, 1.22 [95% CI, 1.01-1.48]; type 2 diabetes IRR, 1.23 [95% CI, 1.14-1.33]). Age had a U-shaped association with hyperglycemic crisis risk in patients with type 1 diabetes (compared with patients aged 18-44 years: 45-64 years IRR, 0.72 [95% CI, 0.59-0.87]; 65-74 years IRR, 0.62 [95% CI, 0.47-0.80]; ≥75 years IRR, 0.96 [95% CI, 0.66-1.38]). In type 2 diabetes, risk of hyperglycemic crises decreased progressively with age (45-64 years IRR, 0.57 [95% CI, 0.51-0.63]; 65-74 years IRR, 0.44 [95% CI, .39-0.49]; ≥75 years IRR, 0.41 [95% CI, 0.36-0.47]). In patients with type 2 diabetes, higher risk was associated with sodium-glucose cotransporter 2 inhibitor therapy (IRR, 1.30; 95% CI, 1.14-1.49) and insulin dependency (compared with regimens with bolus insulin: regimens with basal insulin only, IRR, 0.69 [95% CI, 0.63-0.75]; and without any insulin, IRR, 0.36 [95% CI, 0.33-0.40]).
Conclusions and Relevance: In this cohort study, younger age, Black race/ethnicity, low income, and poor glycemic control were associated with an increased risk of hyperglycemic crises. The findings suggest that multidisciplinary interventions focusing on groups at high risk for hyperglycemic crises are needed to prevent these dangerous events.
References: BMJ Open Diabetes Res Care. 2020 Feb;8(1):. (PMID: 32075810)
JAMA Intern Med. 2019 Jan 1;179(1):112-114. (PMID: 30508012)
J Diabetes Complications. 2017 Jul;31(7):1158-1163. (PMID: 28462891)
Am J Prev Med. 2021 Sep;61(3):394-401. (PMID: 34108111)
Diabetes Care. 1995 Apr;18(4):483-9. (PMID: 7497857)
Prev Chronic Dis. 2018 Nov 21;15:E142. (PMID: 30468422)
MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):362-365. (PMID: 29596400)
JAMA. 2021 Jun 25;:. (PMID: 34170288)
Diabetes. 1996 Mar;45(3):337-41. (PMID: 8593939)
Prev Med. 2007 Mar;44(3):189-95. (PMID: 16997358)
JAMA Intern Med. 2017 Mar 1;177(3):358-368. (PMID: 28097328)
BMJ Open Diabetes Res Care. 2020 Nov;8(2):. (PMID: 33234510)
Diabetes Care. 2017 Apr;40(4):468-475. (PMID: 27659408)
J Clin Endocrinol Metab. 2021 Mar 25;106(4):935-941. (PMID: 33433590)
Health Aff (Millwood). 2011 Feb;30(2):322-31. (PMID: 21289354)
N Engl J Med. 2021 Jun 10;384(23):2219-2228. (PMID: 34107181)
Diabetes Res Clin Pract. 2012 Nov;98(2):249-56. (PMID: 23036785)
Health Aff (Millwood). 2017 Jan 1;36(1):57-66. (PMID: 28069847)
JAMA Netw Open. 2021 Feb 1;4(2):e2035792. (PMID: 33523188)
Diabetes Care. 2020 Oct;43(10):2396-2402. (PMID: 32737138)
Nat Rev Endocrinol. 2016 Apr;12(4):222-32. (PMID: 26893262)
Am J Prev Med. 2009 Jan;36(1):74-81. (PMID: 18977112)
Diabetes. 2004 Mar;53(3):645-53. (PMID: 14988248)
Diabetes Care. 2018 Jun;41(6):1299-1311. (PMID: 29739814)
Ann Intern Med. 2007 Oct 16;147(8):573-7. (PMID: 17938396)
BMJ. 2019 May 29;365:l1114. (PMID: 31142480)
Diabetes Care. 2016 Mar;39(3):363-70. (PMID: 26681726)
JAMA Netw Open. 2020 Jan 3;3(1):e1919099. (PMID: 31922562)
Prev Med. 2014 Jan;58:33-9. (PMID: 24161713)
J Clin Endocrinol Metab. 2021 Mar 25;106(4):e1909-e1916. (PMID: 33496788)
Diabetes Care. 2020 May;43(5):1057-1064. (PMID: 32161050)
Arch Intern Med. 1997 Mar 24;157(6):669-75. (PMID: 9080921)
JAMA. 2016 Apr 5;315(13):1400-2. (PMID: 27046369)
Diabetes Res Clin Pract. 2019 Nov;157:107869. (PMID: 31560962)
Endocrine. 2016 Jan;51(1):72-82. (PMID: 26115971)
N Engl J Med. 2004 Aug 5;351(6):575-84. (PMID: 15295050)
Lancet Diabetes Endocrinol. 2020 May;8(5):436-446. (PMID: 32333879)
Diabetes Care. 2018 Aug;41(8):1631-1638. (PMID: 29773640)
Diabet Med. 2017 Oct;34(10):1361-1366. (PMID: 28727175)
BMJ Open. 2016 Aug 23;6(8):e012233. (PMID: 27554106)
Health Aff (Millwood). 2014 Jul;33(7):1187-94. (PMID: 25006145)
Diabetes Care. 2009 Jul;32(7):1335-43. (PMID: 19564476)
BMJ Open Diabetes Res Care. 2019 Apr 8;7(1):e000621. (PMID: 31114699)
JAMA Intern Med. 2017 Oct 1;177(10):1461-1470. (PMID: 28828479)
Diabetes Care. 2017 Feb;40(2):239-245. (PMID: 27956384)
Diabetes Care. 2016 Oct;39(10):1671-6. (PMID: 27422579)
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3473-3480. (PMID: 31220288)
معلومات مُعتمدة: K23 DK114497 United States DK NIDDK NIH HHS; K23 DK123384 United States DK NIDDK NIH HHS; P30 DK111024 United States DK NIDDK NIH HHS
المشرفين على المادة: 0 (Glycated Hemoglobin A)
0 (Insulin, Regular, Human)
تواريخ الأحداث: Date Created: 20210901 Date Completed: 20220110 Latest Revision: 20221207
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC8411297
DOI: 10.1001/jamanetworkopen.2021.23471
PMID: 34468753
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2021.23471