Diabetes-related Hospitalizations Research Articles

Epidemiological factors affecting outpatient department service utilization and hospitalization in patients with diabetes: A time-series analysis from an Ethiopian hospital between 2018 and 2021.

BackgroundThe burden of diabetes-related deaths reached two million in 2019 globally. Accessibility to health care services and adherence to follow-up and therapy are key to improving outcomes for diabetic patients. We aimed to assess outpatient department (OPD) service utilization and diabetes-related hospitalizations over a period of 44 months.MethodsA retrospective cohort study was conducted on OPD visits and hospitalizations recorded between January 1, 2018, and August 31, 2021, at the St Luke Catholic Hospital (Ethiopia). All diabetic patients were included in the analysis. A linear regression model was used for univariate analysis of OPD visits and hospitalizations and their association with potential predictors. The autoregressive integrated moving average (ARIMA) method was applied to both the time series of OPD visits and hospitalizations. Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature and precipitations.ResultsIn the time series analysis, OPD visits increased over time (P < 0.01) while hospitalizations were stable. The time series model was ARIMA (0,1,1) for OPD visits and ARIMA (0,0,0) for hospitalizations. There were 1685 diabetes OPD patients (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (P < 0.01) and a lower number of hospitalizations per month (P = 0.03). There were 801 patients missing follow-up (48%). The time between follow-up increased with age (P < 0.01). OPD visits decreased differently by geographic area as COVID-19 cases increased (P < 0.01). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. The odds ratio (OR) of new diagnosis at hospitalization was lower in patients with type 2 diabetes (OR = 0.26, 95% CI = 0.14-0.49, P = 0.02).ConclusionsDespite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Female sex, older age, and COVID-19 were associated with impaired OPD service accessibility. Primary health care should be implemented to achieve better health coverage and improve diabetes management.

Epidemiological factors affecting health service utilization in diabetic patients in Ethiopia

Abstract Diabetes-related deaths reached 2 million in 2019. The highest percentage of undiagnosed diabetes (59.7%) was observed in Africa, where accessibility to health services is pivotal to improving the outcome of diabetic patients. The study aims to assess the association between diabetic patients’ epidemiological factors and accessibility to healthcare services in a low-income country. The retrospective cohort study included diabetes-related outpatient department (OPD) visits and hospitalizations from 01/01/2018 to 31/08/2021 at St Luke Hospital (Ethiopia). Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature, and precipitations. The ARIMA method was applied to OPD visits and hospitalizations time series. OPD visits increased over time (p &amp;lt; 0.001) while hospitalizations were stable. The time series model was ARIMA(0,1,1) for OPD visits and ARIMA(0,0,0) for hospitalizations. Diabetes OPD patients were 1,685 (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (p = 0.002). Patients missing follow-up were 801 (48%). The time between follow-ups was longer as age increased (p &amp;lt; 0.001). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. OPD visits decreased differently by geographic area as COVID-19 cases increased (p &amp;lt; 0.001). Hospitalized patients for diabetes were 408, 85 (20.8%) newly diagnosed. The odds ratio (OR) of diagnosis at admission was lower as age increased (OR 0.98, p = 0.009). Compared to type 1 diabetes, hospitalized females with type 2 (117-39.7%) were fewer than males (p = 0.019). Readmissions were 52, 10 (19.2%) within 30 days, without OR difference by sex, age, or diabetes type. Despite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Gender and age influenced service utilization. Females’ access to care is still problematic (concept of “missing women”). Key messages • Primary health care should be implemented to improve access to health services and diabetes management. • Ensuring equity in healthcare accessibility should be a priority in low-income countries.

Quality of Care for US Adults With Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared With Other Primary Care Settings.

The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs. We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models. Overall, laboratory-based process measures occurred more frequently (range, 65.7%-76.6%) than measures requiring specialty referrals (retinal examinations, 33.3%; diabetes education, 3.4%). Compared with non-FQHC patients, FQHC patients had about 3 percentage point lower rates of each process measure, except for higher rates of diabetes education [relative risk=1.09, 95% confidence interval (CI): 1.03-1.16]. FQHC patients had fewer overall [incident rate ratio (IRR)=0.87, 95% CI: 0.86-0.88] and diabetes-related hospitalizations (IRR=0.79, 95% CI: 0.77-0.81), but more overall (IRR=1.06, 95% CI: 1.05-1.07) and diabetes-related emergency department visits (IRR=1.10, 95% CI: 1.08-1.13). This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal examinations or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients versus non-FQHC patients. Despite having higher rates of emergency department visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.

Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults.

Background:Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions.Objectives:The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions compared with usual care.Research Design:Remote pragmatic randomized trial.Subjects:Adults with heart failure, diabetes, or chronic kidney disease being discharged home between April 27, 2020, and June 9, 2021, from 5 hospitals within an integrated health care delivery system.Measures:Participants were prerandomized to 10 weeks of MTMs (with or without virtual nutritional counseling) compared with usual care. The primary outcome was all-cause hospitalization within 90 days after discharge. Exploratory outcomes included all-cause and cause-specific health care utilization and all-cause death within 90 days after discharge.Results:A total of 1977 participants (MTMs: n=993, with 497 assigned to also receive virtual nutritional counseling; usual care: n=984) were enrolled. Compared with usual care, MTMs did not reduce all-cause hospitalization at 90 days after discharge [adjusted hazard ratio, aHR: 1.02, 95% confidence interval (CI), 0.86–1.21]. In exploratory analyses, MTMs were associated with lower mortality (aHR: 0.65, 95% CI, 0.43–0.98) and fewer hospitalizations for heart failure (aHR: 0.53, 95% CI, 0.33–0.88), but not for any emergency department visits (aHR: 0.95, 95% CI, 0.78–1.15) or diabetes-related hospitalizations (aHR: 0.75, 95% CI, 0.31–1.82). No additional benefit was observed with virtual nutritional counseling.Conclusions:Provision of MTMs after discharge did not reduce risk of all-cause hospitalization in adults with nutrition-sensitive conditions. Additional large-scale randomized controlled trials are needed to definitively determine the impact of MTMs on survival and cause-specific health care utilization in at-risk individuals.

Epidemiological Analysis of Diabetes-Related Hospitalization in Poland before and during the COVID-19 Pandemic, 2014-2020.

Diabetes is one of the most common chronic diseases worldwide. The study aimed to present an epidemiological analysis of hospitalization related to diabetes mellitus in Poland between 2014 and 2020 as well as to analyze changes in diabetes-related hospital admissions before and during the COVID-19 pandemic. This study is a retrospective analysis of the national registry dataset of hospital discharge reports on diabetes-related hospitalizations in Poland between 2014 and 2020. The number of diabetes-related hospitalizations varied from 76,220 in 2016 to 45,159 in 2020. The hospitalization rate per 100,000 has decreased from 74.6 in 2019 to 53.0 in 2020 among patients with type 1 diabetes (percentage change: −28.9%). An even greater drop was observed among patients with type 2 diabetes: from 99.4 in 2019 to 61.6 in 2020 (percentage change: −38%). Both among patients with type 1 and type 2 diabetes, a decrease in hospitalization rate was higher among females than males (−31.6% vs. −26.7% and −40.9% vs. −35.2% respectively). When compared to 2019, in 2020, the in-hospital mortality rate increased by 66.7% (60.0% among males and 65.2% among females) among patients hospitalized with type 1 diabetes and by 48.5% (55.2% among females and 42.1% among males) among patients hospitalized with type 2 diabetes. Markable differences in hospitalization rate, duration of hospitalization, as well as in-hospital mortality rate by gender, were observed, which reveal health inequalities.

Feasibility, Acceptability, and Preliminary Efficacy of an Intensive Clinic-Based Intervention for Children With Poorly Controlled Type 1 Diabetes

ObjectiveTo evaluate the feasibility, acceptability, and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia, as detected based on the measurement of hemoglobin A1C (HbA1C). MethodsForty participants with T1D for >1 year and an HbA1C level of ≥9.5% (80 mmol/mol) enrolled for a multidisciplinary intervention that included pediatric endocrinologists, pediatric psychologists, and a certified diabetes care and education specialist (CDCES). The CDCES-integrated medical management, while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals and reviewed medication adjustments. The feasibility was assessed based on enrollment targets; acceptability based on retention rates; and preliminary efficacy based on changes in HbA1C levels, quality of life, diabetes-related strengths and resilience, hospital admissions, emergency room visits, and missed school days. ResultsOf 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention, and 31 completed full 8 months of follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. The HbA1C level reduced significantly from baseline to 4 months (12.1% ± 1.6% to 11.0% ± 1.9%, P = .001) and was sustained at 8 months (10.7% ± 1.9%, P < .001). The participants reported significant increases in diabetes-specific quality of life (P < .05) and diabetes-related strength and resilience (P = .003). The missed school days reduced from 7.23 ± 7.5 days to 1.55 ± 1.9 days (P < .001), and the diabetes-related hospitalizations decreased from 0.4 ± 0.6 to 0.1 ± 0.3 (P = .009). ConclusionPreliminary data suggest that a multidisciplinary intervention leveraging a team-based approach with a physician, psychologist, and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with T1D with an HbA1C level above the target.

A085 Cost analysis of Diabetes-Related Hospitalization in Patients with Obesity After Bariatric Surgery

A085 Cost analysis of Diabetes-Related Hospitalization in Patients with Obesity After Bariatric Surgery

Addressing healthcare disparities and managed care considerations with continuous glucose monitoring.

About 37 million people in the United States have diabetes. Diabetes-related complications are costly and associated with substantial morbidity. By improving glucose control, continuous glucose monitoring (CGM) can reduce costs due to diabetes-related hospitalizations, hypoglycemia, and diabetic ketoacidosis. However, people of color and low socioeconomic status, populations with disproportionately high prevalence of diabetes, face significant inequity in accessing CGM technology. Potential reasons for CGM inequity include implicit bias and differences in coverage between commercial and government insurance. Recent changes to Medicare CGM eligibility criteria have eliminated blood glucose monitoring requirements. However, cost and CGM coverage requirements remain as barriers to the recommended use of this technology as defined in current clinical practice guidelines. Coverage expansion from durable medical equipment to the pharmacy benefit may improve access. Other strategies to optimize CGM utility overall include integrating CGM data directly into electronic health records for population health management and diabetes control performance measures based on CGM data in value-based contracts (VBCs). VBCs may encourage real-world data generation which in turn may bolster stakeholder support for the equitable use and coverage of CGM in diabetes management.

Ambulatory management of diabetic foot complications

Diabetic foot infection (DFI) is the most common reason for diabetes-related hospital admissions and is the proximate cause in 60% of lower extremity amputations.[1][1] With a strong evidence base and respected published guidelines, the foundations are in place for the provision of high-quality care

Accountable Care Organizations and Health Disparities of Rural Latinos: A Longitudinal Analysis.

The purpose of this study was 2-fold: (1) to analyze the change in diabetes-related hospitalization rates of rural Latino older adult patients as compared with their White counterparts and (2) to determine what factors, including rural health clinic (RHC) participation in accountable care organizations (ACOs), are related to reduced disparities in diabetes-related hospitalization rates. Data for Latino Medicare beneficiaries who were served by RHCs over an 8-year period were analyzed. First, a difference-of-means test was conducted to determine whether there was a change in disparity from the pre-ACO period (2008-2011) to the post-ACO period (2012-2015). A statistically significant decrease in disparity over time was found (t = -7.6899, df = 115, P < 0.001.) Second, multiple regression analyses of 3 separate models were conducted to determine whether ACO participation contributed to reducing disparities in diabetes-related hospitalization rates between Latinos and Whites. The analyses indicated moderate evidence that consistent ACO participation is associated with lower health disparities (t = -1.947, P = 0.0525). However, this association is not significant after balancing covariates, and no causal relationship can be established. Latinos compose one of the fastest growing groups in rural as well as urban areas of the United States. It is critical that ACOs, with their emphasis on care coordination, health care quality, and value, monitor their provision of services to Latinos, rural, and other vulnerable populations.

Trajectories of glycemic control with clinical pharmacy specialist management of veterans with type 2 diabetes.

Improved control of glycemic control likely lowers the risk of diabetes complications and clinical pharmacy specialist (CPS) services can improve glycemic control. Though the pattern of control may also matter in terms of outcomes. The objective of this study was to examine the longitudinal trajectories of HbA1c among a large population of Veterans with type 2 diabetes who received CPS-led diabetes management. This is an observational, multicenter cohort study of Veterans with type-2 diabetes managed by CPSs between 7/1/2013 and 7/1/2017 with baseline glycosylated hemoglobin (HbA1c) level ≥8%. Two years of HbA1c measurements were used to group patients into distinct patterns of HbA1c trajectories over time using group-based trajectory modeling. Characteristics associated with successful HbA1c trajectories and association of assigned trajectories with all-cause and diabetes-related hospitalizations were analyzed using logistic regression. A total of 4119 Veterans were included and able to be successfully segmented into six distinct HbA1c trajectory groups over time: High Gradually Decreasing (n=325, 7.9%), Moderate Early Decline (n=1692, 41.1%), Large Early Decline (n=231, 5.6%), Uncontrolled Stable (n=1468, 35.6%), Early Decline/Subsequent Increase (n=266, 6.5%), and Very Uncontrolled Stable (n=137, 3.3%). The distinguishing factor between successful and less successful trajectories appears to be the progress made within the first six months of pharmacist management. Significant variability exists in the pattern of glycemic control over time of type 2 diabetes patients managed by clinical pharmacy specialists. Limited resources should be first prioritized to managing patients with very elevated HbA1c and into the first six months of CPS management.

1147-P: Trends in Diabetes-Related Foot Disease Hospitalization, Revascularization, and Amputations in Australia 20to 2019

Hospitalization for diabetes-related foot disease adds considerable burden for people living with diabetes and often leads to lower extremity amputation. We evaluated trends in the incidence of foot disease related hospital admission, revascularization and amputation procedures among people with type 1 and type 2 diabetes in Australia from 2010-2019. We included 70,766 people with type 1, and 1.1 million people with type 2 diabetes from the Australian diabetes registry (55% male) . We linked the diabetes registry to hospital admissions data to obtain the number of hospital admissions for foot disease, revascularization and amputation procedures. We estimated the annual incidence rates, using people with diabetes as the denominator, and evaluated trends over time with Joinpoint regression. In type 1 diabetes, rates of admission for foot disease and revascularization increased, while amputation rates were relatively stable (Table) . In type 2 diabetes, rates of foot disease admission and revascularization increased. While above the knee amputations decreased, below the knee amputations were stable, and foot and toe amputations increased. Average annual percent changes were generally higher for men than women (i.e. men showed greater increases or less of a decrease over time) . These findings highlight the importance of improving management of diabetes-related foot disease. Disclosure M.Quigley: None. J.I.Morton: None. P.A.Lazzarini: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. D.J.Magliano: None. Funding MQ is supported by an Australian Government Research Training Program (RTP) Scholarship. JIM is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. PAL is supported by a National Health and Medical Research Council Early Career Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government’s Operational Infrastructure Support Program.

954-P: Barriers to Enrollment in a Continuous Glucose Monitoring Pilot Program for Medicaid Patients

Background: CGM usage is associated with lower A1c and decreased diabetes-related hospitalizations and emergency room visits. However, there are still many barriers to accessing CGM, with the most prominent being cost and cumbersome insurance eligibility criteria. We aimed to explore and describe barriers to enrollment in a pilot CGM program for Ohio Medicaid patients. Methods: Patients seen at a large academic medical center in the past year, a diabetes diagnosis and A1c &amp;gt;8.5% were identified by Medicaid. The pilot CGM program removed the need for the common CGM coverage requirements of prior authorizations, multiple daily injections, and glucose logs. Patients had to use a mobile CGM application to participate. Patients were contacted via phone and agreeable participants saw a diabetes care and education specialist for CGM education and initiation and an ambulatory care pharmacist for follow-up. Baseline characteristics were obtained via chart review and data were analyzed using descriptive analyses. Results: N=43 were contacted for enrollment (mean age 43.4±10.8 years; 88.4% female; 93.0% African American; mean A1c 10.2±2.0%; 58.1% on multiple daily injections) . In total, n=16 (37.2%) agreed to participate, n=17 (39.5%) were unable to be contacted, n=8 (18.6%) were already actively using CGM and n=2 (4.7%) declined to participate. Older age predicted agreeance to participate (β=0.350, p=.022) . Those who agreed to participate were more likely to see primary care over endocrinology for diabetes care X 2 (1, N=43) = .62, p=0.018. At one-month post-program enrollment, only n=2 (4.7%) patients successfully started CGM. Discussion: Although over one-third of participants agreed to enroll in the CGM pilot, there was low CGM initiation. Removal of cost and insurance coverage requirements alone did not result in high CGM adoption. Patients were difficult to reach via phone and offering CGM initiation and education during primary care appointments may improve CGM access and utilization. Disclosure W.Chen: None. J.E.Blanchette: Advisory Panel; Cardinal Health, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Insulet Corporation, Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care &amp; Education Specialists. J.Macwilliams: None. B.Hatipoglu: None.

In vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure) against polymicrobial communities and individual bacterial strains derived from diabetic foot infections.

Introduction. Diabetic foot infection (DFI) is the main reason for diabetes-related hospitalisation and is a major cause of diabetes-related amputation. DFIs are often complicated by ischaemia in the affected limb, the presence of polymicrobial biofilms and increasingly the occurrence of antibiotic resistant bacteria.Hypothesis/Gap statement. Antibiotic loaded beads could inhibit the growth of polymicrobial DFI communities with differing compositions in vitro.Aim. This study investigates the in vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure, Biocomposites Ltd., UK) against polymicrobial DFI communities and individual bacterial strains derived from DFIs.Methodology. Debrided tissue obtained from the base of infected diabetic foot ulcers was homogenised and spread over the surface of Columbia blood agar (CBA) and fastidious anaerobe agar (FAA) plates. Calcium sulfate beads containing a combination of vancomycin and gentamicin were then placed on the surface of the agar and following incubation, zones of inhibition (ZOI) were measured. For individual bacterial strains isolated from the infected tissue, calcium sulfate beads containing vancomycin, gentamicin, flucloxacillin or rifampicin and beads containing a combination of vancomycin and gentamicin or flucloxacillin and rifampicin were tested for their ability to inhibit growth.Results. Calcium sulfate beads loaded with a combination of vancomycin and gentamicin were able to inhibit bacterial growth from all polymicrobial tissue homogenates tested, with ZOI diameters ranging from 15 to 40 mm. In the case of individual bacterial strains, beads containing combinations of vancomycin and gentamicin or flucloxacillin and rifampicin were able to produce ZOI with Gram-positive facultatitive anaerobic strains such as Staphylococcus aureus and Enterococcus faecalis, Gram-negative facultative anaerobic strains such as Pseudomonas aeruginosa and obligate anaerobic strains such as Finegoldia magna even where acquired resistance to one of the antibiotics in the combination was evidenced.Conclusion. The local use of calcium sulfate beads containing a combination of two antibiotics demonstrated high efficacy against polymicrobial DFI communities and individual DFI bacterial strains in in vitro zone of inhibition tests. These results show promise for clinical application, but further research and clinical studies are required.

Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados.

BackgroundPeripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.MethodsMultistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.ResultsOf 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43).ConclusionAsymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.

The effects of patient out-of-pocket costs for insulin on medication adherence and health care utilization in patients with commercial insurance; 2007-2018.

BACKGROUND: High out-of-pocket costs (OOPCs) for insulin can lead to cost-related nonadherence and poor outcomes, prompting payers to limit insulin OOPCs. However, data are scarce on whether insulin OOPCs at policy-relevant levels is associated with improved adherence and outcomes. OBJECTIVE: To identify associations between insulin OOPCs and insulin adherence, noninsulin antihyperglycemic (AHG) medication adherence, and diabetes-related emergency department (ED) visits and hospitalizations. METHODS: This retrospective cohort study was conducted using OptumLabs Data Warehouse, a longitudinal, real-world data asset with deidentified administrative claims and electronic health record data. Individuals with type 1 diabetes (T1D) or type 2 diabetes (T2D), insulin use on January 1 of a study year (index date: 2007-2018), continuous commercial health plan eligibility 12 months pre-index and post-index date, and at least 1 insulin claim during the 12-month follow-up period were included. Average insulin OOPCs per 30-day supply in the follow-up period was identified and categorized ($0, > $0-$20 [referent group], > $20-$35, > $35-$50, and > $50). The proportion of patients with a gap in insulin supply of 60 or more continuous days, AHG nonadherence per modified proportion of days covered less than 0.80, and a diabetes-related ED visit or hospitalization were identified and compared by insulin OOPC category vs more than $0 to $20 using pairwise chi-square tests and multivariable logistic regression. RESULTS: The study included 21,085 individuals with T1D and 72,512 with T2D. Patients with average OOPCs more than $50 were more likely to have a gap in insulin supply vs those with OOPCs more than $0 to $20, with an odds ratio (OR) of 1.14 (95% CI =1.05-1.24) and 1.38 (95% CI = 1.32-1.45) for T1D and T2D, respectively. Those with T2D and OOPCs more than $35 were also more likely to have a 60-day gap in insulin supply (OR 1.17; 95% CI = 1.11-1.23). Odds of having a diabetes-related hospitalization or ED visit did not increase with higher OOPCs; rather, associations tended to be inverse. Nonadherence to AHG medications in the T2D cohort was higher with insulin OOPCs more than $20 vs those more than $0-$20 (P < 0.05 for all). CONCLUSIONS: Individuals with T2D were more likely to have a 60-day gap in insulin supply when the OOPC was more than $35 per 30-day supply and with the OOPC more than $50 in those with T1D. These findings suggest that health plans can facilitate adherence to insulin therapy and possibly to noninsulin AHG medications by protecting patients with diabetes from experiencing high insulin OOPC. A study with a longer follow-up period is warranted to fully assess ED and hospitalization outcomes. DISCLOSURES: This study was funded by the Robert Wood Johnson Foundation, Health Data for Action Research Program. The study sponsor played no role in the design or conduct of this study. The views expressed here do not necessarily reflect the views of the Foundation.

Trends and Demographic Disparities in Diabetes Hospital Admissions: Analyses of Serial Cross-Sectional National and State Data, 2008-2017.

To analyze national and state-specific trends in diabetes-related hospital admissions and determine whether disparities in rates of admission exist between demographic groups and geographically dispersed states. We conducted serial cross-sectional analyses of the National Inpatient Sample (2008, 2011, 2014, and 2016) and State Inpatient Databases for Arizona, Florida, Kentucky, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Utah, and Vermont for 2008, 2011, 2014, and 2016/2017 among adult patients with type 1 and type 2 diabetes-related ICD codes (ICD-9 [250.XX] or ICD-10 [E10.XXX, E11.XXX, and E13.XXX]. We measured hospitalization rates for people with diabetes (all-cause hospitalizations) and for admissions with a primary diagnosis of diabetes or diabetes-related complications (diabetes-specific hospitalizations) per 10,000 people per year. Nationally, all-cause and diabetes-specific hospitalizations declined by 3.1% (95% CI -5.5, -0.7) and 19.1% (95% CI -21.6, -16.6), respectively, over 2008 to 2016. The analysis of individual states showed that diabetes-specific admissions in individuals ≥65 years old declined during this time (16.3-48.8% decrease) but increased among patients 18-29 years old (10.5-81.5% increase) and that rural diabetes-specific admissions decreased in just over half of the included states (15.2-69.2% decrease). There were no differences in changes in admission rates among different racial/ethnic groups. Overall, rates of diabetes-related hospitalizations decreased over 2008 to 2016/2017, but there were large state-level differences across subgroups of patients. The rise in diabetes hospitalizations among young adults is a cause for concern. These state- and subpopulation-level differences highlight the need for state-level policies and interventions to address disparities in diabetes health care use.

IDF21-0390 Diabetes related hospital presentations to South-Western Sydney during COVID Pandemic: A retrospective analysis

Background: Diabetes is an independent risk factor for critical outcomes in patients with COVID-19. Social distancing, restrictions and public anxiety had an impact on medical care access for patients. This raised concerns that diabetes-related presentations to emergency department may have increased in 2020. Aim: The aim of this study was to compare diabetes related presentations to the Emergency Department (ED) in South-Western Sydney, rates of newly diagnosed diabetes before and during the COVID-19 pandemic, and to assess the impact of pandemic related restrictions on rates of diabetes related presentations to ED. Method: We conducted a retrospective audit of diabetes-related presentations to emergency department between March-September 2020 compared to similar period in 2019 at 2 Sydney hospitals. Their demographics, principal diagnosis and precipitating factors for admission were assessed. Results: Between March and September, for patients with diabetes, there were 494 presentations in 2019, compared to 446 in 2020, and majority had type 2 diabetes. Most patients were not known to hospital diabetes services (86.8% in 2019 vs 89.0% in 2020, p = 0.301). There was no difference in rates of diabetic ketoacidosis (13.8% in 2019 vs 15.5% in 2020, p = 0.460) or hyperosmolar hyperglycaemic state (5.1% in 2019 vs 7.0% in 2020, p = 0.222) between the two years. A higher rate of hyperglycaemia presentations was observed in 2020 (64.8%) than in 2019 (46.4%, p < 0.001). There was no difference in hypoglycaemia (19.6% in 2019 vs 21.5% in 2020, p = 0.474) or new onset diabetes (8.5% in 2019 vs 7.4% in 2020, p = 0.677) as the cause for presentation. Presentations related to compliance issues were lower in 2019 compared to 2020 (15.6 vs 20.7%, p = 0.044). Infection was the commonest precipitating factor: similar across both years (33.3% in 2019 vs 33.0% in 2020). Discussion: In conclusion, our study found that the number of presentations amongst patients with diabetes to emergency departments was similar between the two years. However we observed a higher rate of hyperglycemia-related presentations in 2020. Presentations related to compliance issue were more frequent in 2020. This may have been due to limited access of patients with diabetes to health care professionals during the COVID-19 pandemic.

Exploring Problem Areas of Elderly Patients with Diabetes and the Support Provided by Their Family

Objective: Diabetes increases problems in emotional areas particularly among the elderly patients by aggravating negative emotions such as loss, anxiety and fear and makes these patients need higher level of family support. This study aims at exploring problematic areas of the elderly diabetic patients and their family support levels.&#x0D; Methods: The data of this descriptive study were collected by the researcher by conducting a face to face interview with 218 elderly diabetic patients who presented to Endocrine Polyclinics of State Hospital between October 2015 and October 2016. To collect the data, “Patient Information Form”, “Problem Areas in Diabetes Scale (PAID)” and “Hensarling’s Diabetes Family Support Scale (HDFSS)” were used.&#x0D; Results: Although problem areas among the patients were found to be fewer than expected; it was found that there were significant differences between problem areas and “sex, diabetes time, treatment type, length of oral antidiabetic medicine use and insulin use, development of diabetes-related complication and hospitalization due to these complications in the recent year” (p

Trends in Health Disparities of Rural Latinos Pre- and Post-Accountable Care Organization Implementation.

We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts. A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008 - 2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period. Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of "ACO RHCs," there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel. There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs. This paper presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the U.S. healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.