Emergency Department Access in Diabetic Patients

Abstract

Introduction: Access of diabetic patients to Emergency Departments (ED) is an indicator of the filtering capabilities of territorial services. Aims: To analyze the access to ED of the Trento province (540.000 inhabitants-north-east Italy) by diabetic patients in the period 2012-2016. Methods: Accesses of diabetics patients (ICDIXCM 250-251), were analyzed from the Database of ED considering year, gender, age class, month and week day, citizenship, way of arrival, triage score, area (urban/rural) of the residents cases, the proportion of hypoglycemia accesses, hospitalization. Results: A total of 2839 diabetic patients accessed to the ED in the study period (567/year), 70% were type 2. The time trend is slightly decreasing. Males are 54%; the age group 0-14:6%, 15-29 5%, 30+years 89%. Males median age is 61 y, Females median age 66 y. Foreigners represent 10% of the cases. Most subjects arrived by ambulance/helicopter (44%); 2,7% were in red code. There were no differences in relation to the month or day of the week; 52.7% are hospitalized. The ED access rate is 7.7/10.000/year for urban and 10/10.000/year for rural area residents (p<0,01). Hypoglycemia occur in 28% of total access of diabetics without any change over time; 60% were in type 1. There were no differences in relation to gender and age-class, compared to general cases and no change in relation to the month or day of the week or geographical area for resident cases as well. Patients with hypoglycemia at access are more serious considering that 76% accessed by ambulance or helicopter and 4.2% were in red code (p<0,001). The proportion of hospitalized cases is 30,2%, lower than the general case series. Conclusions: The access of diabetic patients to the ED of the province of Trento does not change over time. The proportion of patients with hypoglycemia is considerable, with a higher prevalence in case of type 1 diabetes. It does not change over time and requires substantial costs for the transfer to health structures. Disclosure S. Piffer: None.