Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Socio-demographic and clinical characteristics of type 1 diabetes patients associated with emergency room visits and hospitalizations in Mexico

Authors: Svetlana V. Doubova, Aldo Ferreira-Hermosillo, Ricardo Pérez-Cuevas, Casper Barsoe, Erick Gryzbowski-Gainza, Juan E. Valencia

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

To describe the demographic and clinical characteristics of Type 1 diabetes (T1D) patients affiliated with the Mexican Institute of Social Security (IMSS) and ascertain the socio-demographic and clinical risk factors associated with emergency room (ER) visits and diabetes-related hospitalizations.

Methods

We conducted secondary data analysis of a cross-sectional study. The study included T1D patients 18 years of age and older who in 2016 attended follow-up visits at the endocrinology department of two IMSS tertiary care hospitals in Mexico City. The study variables included demographics, acute and chronic complications, and healthcare services utilization. Multiple Poisson and negative binomial regressions served to determine the association between the study covariates and the dependent variables: ER visits and diabetes-related hospitalizations.

Results

The study included 192 patients, of which 29.2% were men; average age was 32.3 years, with only 13.6% controlled (glycosylated hemoglobin (HbA1C) < 7%); the mean HbA1C was 9.2, and 64.6% presented chronic complications. During 2016, 39.0% visited ER services, and 33.9% were hospitalized. The common risk factors for ER visits and hospitalization were older age at the beginning of diabetes, severe acute complications, chronic microvascular and macrovascular complications, and other comorbidities. Female sex, high school education, depression, and repeated visits to the endocrinologist were associated with ER visits, whereas active smoking and the interaction between diabetes duration > 10 years and HbA1c > 9.0% were additional risk factors for hospitalization.

Conclusion

The poor clinical conditions of T1D patients contribute to explain the escalating demand for health services for diabetes patients at the IMSS. The identification of risk factors enables focalizing interventions to improve the health outcomes of T1D patients and reduce the proportion of ER visits and hospital admissions.
Literature
1.
Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin N Am. 2010;39(3):481–97.CrossRef
2.
3.
Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology, presentation, and management. Pediatr Clin N Am. 2005;52:1553–78.CrossRef
4.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care. 2009;32(Suppl 1):S62–7.
5.
Orchard TJ, Costacou T, Kretowski A, Nesto RW. Type 1 diabetes and coronary artery disease. Diabetes Care. 2006;29(11):2528–38.CrossRefPubMed
6.
Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2016;5(1):49–56.PubMed
7.
Romero-Aroca P, Navarro-Gil R, Valls-Mateu A, Sagarra-Alamo R, Moreno-Ribas A, Soler N. Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study. Br J Ophthalmol. 2017;101(10):1346–51.CrossRefPubMedPubMedCentral
8.
9.
Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, Leese G, Leslie P, McCrimmon RJ, Metcalfe W, McKnight JA, Morris AD, Pearson DW, Petrie JR, Philip S, Sattar NA, Traynor JP, Colhoun HM; Scottish Diabetes Research Network epidemiology group; Scottish Renal Registry. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA 2015;313(1):37–44.
10.
Huo L, Harding JL, Peeters A, Shaw JE, Magliano DJ. Life expectancy of type 1 diabetic patients during 1997-2010: a national Australian registry-based cohort study. Diabetologia. 2016;59(6):1177–85.CrossRefPubMed
11.
Lind M, Svensson AM, Kosiborod M, Gudbjörnsdottir S, Pivodic A, Wedel H, Dahlqvist S, Clements M, Rosengren A. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371(21):1972–82.CrossRefPubMed
12.
Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W, Frier BM, Morris AD, DARTS/MEMO Collaboration. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. 2003;26(4):1176–80.CrossRefPubMed
13.
Woo VC, Carter ME, Bialy M, Abdulrehman J. Emergency Room Visits: Comparison of Individuals with Type 1 and Type 2 Diabetes Against Individuals Without Diabetes. Diabetes. 2007;56(Supplement 1):A618.
14.
15.
Lipton RB, Zierold KM, Drum ML, Klein-Gitelman M, Kohrman AF. Re-hospitalization after diagnosis of diabetes varies by gender and socioeconomic status in urban African-American and Latino young people. Pediatr Diabetes. 2002;3(1):16–22.CrossRefPubMed
16.
Palta M, Lecaire T, Daniels K, Shen G, Allen C, D'Alessio D. Risk factors for hospitalization in a cohort with type 1 diabetes. Wisconsin Diabetes Registry Am J Epidemiol. 1997;146(8):627–36.PubMed
17.
Hamman RF, Cook M, Keefer S, Young WF, Finch JL, Lezotte D, McLaren B, Orleans M, Klingensmith G, Chase HP. Medical care patterns at the onset of insulin-dependent diabetes mellitus: association with severity and subsequent complications. Diabetes Care. 1985;8(suppl l):94–100.CrossRefPubMed
18.
Govan L, Wu O, Briggs A, Colhoun HM, Fischbacher CM, Leese GP, McKnight JA, Philip S, Sattar N, Wild SH, Lindsay RS, Scottish Diabetes Research Network Epidemiology Group. Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish diabetes research network epidemiology group. Diabetes Care. 2011;34(9):1992–7.CrossRefPubMedPubMedCentral
19.
Butalia S, Johnson JA, Ghali WA, Rabi DM. Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with type 1 diabetes. Diabet Med. 2013;30(5):567–73.CrossRefPubMed
20.
Tomlin AM, Dovey SM, Tilyard MW. Risk factors for hospitalization due to diabetes complications. Diabetes Res Clin Pract. 2008;80(2):244–52.CrossRefPubMed
21.
Moss SE, Klein R, Klein BE. Risk factors for hospitalization in people with diabetes. Arch Intern Med. 1999;159(17):2053–7.CrossRefPubMed
22.
Levine BS, Anderson BJ, Butler DA, Antisdel JE, Brackett J, Laffel LM. Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. J Pediatr. 2001;139(2):197–203.CrossRefPubMed
23.
Menzin J, Korn JR, Cohen J, Lobo F, Zhang B, Friedman M, Neumann PJ. Relationship between glycemic control and diabetes-related hospital costs in patients with type 1 or type 2 diabetes mellitus. J Manag Care Pharm. 2010;16(4):264–75.PubMed
24.
Donnan PT, Leese GP, Morris AD, Diabetes Audit and Research in Tayside, Scotland/Medicine Monitoring Unit Collaboration. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use. Diabetes Care. 2000;23(12):1774–9.CrossRefPubMed
25.
Gómez-Díaz RA, Pérez-Pérez G, Hernández-Cuesta IT, Rodríguez-García JC, Guerrero-López R, Aguilar-Salinas CA. Incidence of Type 1 Diabetes in Mexico: Data From an Institutional Register 2000–2010. Diabetes Care. 2012;35:e77.CrossRefPubMedPubMedCentral
26.
Mexican Institute of Social Security. Report to the Federal Executive and congress of the union on the financial situation and risks of the Mexican Institute of Social Security 2015–2016. México: IMSS; 2016.
27.
Mexican Institute of Social Security. Report to the Federal Executive and congress of the union on the financial situation and risks of the Mexican Institute of Social Security 2015–2016. México: IMSS; 2017.
28.
Ascencio-Montiel Ide J, Kumate-Rodríguez J, Borja-Aburto VH, Fernández-Garate JE, Konik-Comonfort S, Macías-Pérez O, Campos-Hernández Á, Rodríguez-Vázquez H, López-Roldán VM, Zitle-García EJ, Solís-Cruz Mdel C, Velázquez-Ramírez I, Aguilar-Jiménez M, Villa-Caballero L, Cisneros-González N. Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes. BMC Public Health. 2016;16:921. https://​doi.​org/​10.​1186/​s12889-016-3598-4.CrossRefPubMed
29.
Persson S, Dahlquist G, Gerdtham UG, Steen Carlsson K, Swedish Childhood Diabetes Study Group. Why childhood-onset type 1 diabetes impacts labour market outcomes: a mediation analysis. Diabetologia. 2018;61(2):342–53.CrossRefPubMed
30.
Persson S, Gerdtham UG, Steen Carlsson K, Swedish Childhood Diabetes Study G. Labor market consequences of childhood onset type 1 diabetes. Econ Hum Biol. 2016;23:180–92.CrossRefPubMed
31.
Méndez-Durán A, Ignorosa-Luna MH, Pérez-Aguilar G, Rivera-Rodríguez FJ, González-Izquierdo JJ, Dávila-Torres J. Current status of alternative therapies renal function at the Instituto Mexicano del Seguro Social. Rev Med Inst Mex Seguro Soc. 2016;54(5):588–93.PubMed
32.
Cisneros-González N, Ascencio-Montiel IJ, Libreros-Bango VN, Rodríguez-Vázquez H, Campos-Hernández Á, Dávila-Torres J, Kumate-Rodríguez J, Borja-Aburto VH. Lower extremity amputation rates in diabetic patients. Rev Med Inst Mex Seguro Soc. 2016;54(4):472–9.PubMed
33.
Wilson Van Voorhis CR, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3:43–50.CrossRef
34.
35.
36.
Schoenaker DA, Simon D, Chaturvedi N, Fuller JH, Soedamah-Muthu SS, EURODIAB prospective complications StudyGroup. Glycemic control and all-cause mortality risk in type 1 diabetes patients: the EURODIAB prospective complications study. J Clin Endocrinol Metab. 2014;99(3):800–7.CrossRefPubMed
37.
Wadén J, Forsblom C, Thorn LM, Gordin D, Saraheimo M, Groop PH, Finnish Diabetic Nephropathy Study Group. A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes. Diabetes. 2009;58(11):2649–55.CrossRefPubMedPubMedCentral
38.
Gómez AM, Grizales AM, Veloza A, Marín A, Muñnoz OM, Rondón MA. Factores asociados con el control glucémico óptimo en pacientes tratados con bomba de insulina y monitorización continua de glucosa en tiempo real. Av Diabetol. 2013;29(3):74–80.CrossRef
39.
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, Nathan DM, Zinman B, Cleary PA, Backlund JY, Genuth S, Miller R, Orchard TJ. Modern day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983–2005). Arch Intern Med. 2009;169(14):1307–16.CrossRef
40.
Ishtiak-Ahmed K, Carstensen B, Pedersen-Bjergaard U, Jørgensen M. Incidence trends and Predictorsof hospitalization for hypoglycemia in 17,230 adult patients with type 1 diabetes: a Danish register linkage cohort study. Diabetes Care. 2017;40:226–32.CrossRefPubMed
41.
42.
Ingram WM, Weston C, Ritchie MD, Larson S. Depression linked to frequent Emergency Department use in large 10-year retrospective analysis of an integrated health care system. BioRxiv: The preprint server for biology. Posted online March 9, 2017. https://​doi.​org/​10.​1101/​115238.
43.
44.
Meltzer AC, Bregman B, Blanchard J. Depression is associated with repeat emergency department visits in patients with non-specific abdominal pain. West J Emerg Med. 2014;15:325–8.CrossRefPubMed
45.
Vestberg D, Rosengren A, Olsson M, Gudbjörnsdottir S, Svensson AM, Lind M. Relationship between overweight and obesity with hospitalization for heart failure in 20,985 patients with type 1 diabetes. Diabetes Care. 2013;36:2857–61.CrossRefPubMedPubMedCentral
46.
Jeitler K, Horvath K, Berghold A, Gratzer TW, Neeser K, Pieber TR, Siebenhofer A. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia. 2008;51(6):941–51.CrossRefPubMed
47.
Roze S, Smith-Palmer J, Valentine W, de Portu S, Nørgaard K, Pickup JC. Cost-effectiveness of continuous subcutaneous insulin infusion versus multipledaily injections of insulin in Type 1 diabetes: a systematic review. Diabet Med. 2015;32(11):1415–24.CrossRefPubMed
48.
Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med. 2012;157:336–47.CrossRefPubMed
49.
50.
Bertakis KD, Azari R. The influence of obesity, alcohol abuse, and smoking on utilization of healthcare services. Fam Med. 2006;38(6):427–34.PubMed
51.
52.
Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008;48(5):622–36.CrossRefPubMed
53.
Merrick ES, Hodgkin D, Garnick DW, Horgan CM, Panas L, Ryan M, Blow FC, Saitz R. Older adults' inpatient and emergency department utilization for ambulatory-care-sensitive conditions: relationship with alcohol consumption. J Aging Health. 2011;23(1):86–111.CrossRefPubMed
Metadata
Title
Socio-demographic and clinical characteristics of type 1 diabetes patients associated with emergency room visits and hospitalizations in Mexico
Authors
Svetlana V. Doubova
Aldo Ferreira-Hermosillo
Ricardo Pérez-Cuevas
Casper Barsoe
Erick Gryzbowski-Gainza
Juan E. Valencia
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3412-3

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Analysis of health service utilization of migrants in Beijing using Anderson health service utilization model

Research article

Research capacity building frameworks for allied health professionals – a systematic review

Research article

Qualitative assessment of the primary care outcomes questionnaire: a cognitive interview study

Research article

Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY

Study protocol

Responding to excessive alcohol consumption in third-level (REACT): a study protocol

Research article

The effect of informal caregiver support on utilization of acute health services among home care clients: a prospective observational study