Secondary Diagnosis Of Diabetes Research Articles

Analysis Of Oklahoma Amputation Trends and Identification of Risk Factors to Target Areas For Limb Preservation Interventions

BackgroundAnnual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall healthcare performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. Study DesignWe conducted a 12-consecutive-year observational study using Oklahoma’s hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using ICD-9 and ICD-10 codes. Amputation rates were calculated per 1,000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. ResultsOver 5,000,000 discharges were identified from 2008-2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per thousand discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC: 6.0, 95% CI:4.7-7.3). Most amputations were minor (59.5%), and though minor increased at a faster rate compared to major (minor amputation APC: 8.1, 95% CI: 6.7-9.6 vs. major amputation APC: 3.1, 95% CI:1.5-4.7), major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (p=0.001) when compared within their respective category. ConclusionAmputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide healthcare problem. We also present imperative examples of amputation healthcare disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.

Within and across country variations in treatment of patients with heart failure and diabetes.

To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.

Diabetes in the Hospital—A Nationwide Analysis of all Hospitalized Cases in Germany With and Without Diabetes, 2015-2017.

Comprehensive data on the frequency of diabetes mellitus among hospitalized patients in Germany have not been published to date. Among all inpatient cases aged ≥20 years that were documented in the German DRG statistics for 2015-2017, we analyzed the frequencies of five types of diabetes (type 1, type 2, other/pancreatic diabetes, "rare diabetes" with an ICD code of E12 or E14, gestational diabetes) and of prediabetes, stratified by sex and age group. The presence of any of these conditions was ascertained from the corresponding ICD-10 code among the main diagnoses (reasons for admission) or secondary diagnoses. We also compared the length of hospital stay, in-hospital mortality, and the frequency of various categories of main diagnosis in cases with and without diabetes in each age group. In the period 2015-2017, approximately 18% of the 16.4 to 16.7 million inpatient cases carried a main or secondary diagnosis of diabetes (in 2017: type 2, 17.1%; type 1, 0.5%). Diabetes was more common in male cases than in female cases (in 2017: type 2, 19.7% vs. 14.8%; type 1, 0.5% vs. 0.4%). In 2017, the greatest difference in length of hospital stay between patients with and without diabetes was for patients with type 1 diabetes aged 40-49 (7.3 vs. 4.5 days), while the greatest difference in in-hospital mortality was for patients with type 2 diabetes aged 70-79 (3.7% vs. 2.8%). From the age of 30 (age category 30-39), diseases of the cardiovascular system, and from the age of 50 (age category 50-59), diseases of the respiratory or urogenital systems were more frequently listed as a reason for admission in cases with than in those without diabetes. The fact that diabetes is twice as prevalent in hospitalized cases as in the general population underscores the high morbidity associated with the disease and the greater need of persons with diabetes for in-hospital care, as the population of multimorbid diabetes patients continues to grow older.

MON-643 Diabetes’ Cost to Us Taxpayers: Thirty-Day Readmission and Resource Utilization Among Diabetics Patients Admitted with ST-Elevation Myocardial Infarction: A Propensity Score Match Analysis

PURPOSE: To determine the relationship between diabetes and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who were admitted with ST-Elevation Myocardial Infarction (STEMI) in the United States. METHOD: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥ 18 years) with a primary diagnosis of STEMI (1), along with a secondary diagnosis of diabetes were identified using ICD-9 codes as described in the literature (2). The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders (3). Independent risk factors for readmission were identified using a Cox proportional hazards model (4). RESULTS: In total, 116,124 hospital admissions among adults with a primary diagnosis of STEMI were identified, of which 18.05% were diabetics. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score. The 30-day rate of readmission among diabetics and non-diabetics with STEMI were 9.31% vs. 6.18% (p <0.001). The most common readmission for both groups was recurrent myocardial infarction. During the index admission for STEMI, the length of stay (LOS) among diabetics and non-diabetics patients were not statistically different (4.74 vs 4.58 days, p=0.12). However, the total hospital cost for the diabetic patients was statistically different ($27,027 vs $24,807, p <0.001). Most importantly, diabetics patients’ in-hospital mortality rate during their index admission was significant higher (10.20% vs 5.92%, p <0.001). Amongst those readmitted, the LOS, total hospital cost, or in-hospital mortality among diabetics were not statistically different when compared to their counterparts during their readmission. Diabetes (HR 1.60, CI 1.27-2.02, p <0.001) was an independent predictor associated with higher risks of readmission. Other independent predictors associated with increased 30-day readmission include acute exacerbation of CHF, acute exacerbation of COPD, acute kidney injury, secondary diagnosis of pneumonia, history of COPD, history of ischemic stroke, history of atrial fibrillation & atrial flutter, history of chronic kidney disease, history of iron deficiency, and use of mechanical ventilator. CONCLUSION: In this study, diabetics patients admitted with STEMI have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p <0.001) than their non-diabetic counterparts.

Implementation and Effect of a Pharmacist-to-Pharmacist Transitions of Care Initiative on Ambulatory Care Sensitive Conditions.

One of the most vulnerable times in a patient's encounter with a health care system is during transitions of care (TOC), defined by the Joint Commission as the movement of a patient from one health care provider or setting to another. The use of a clinical pharmacist as a member of the care transitions team has received focused attention and shown improved benefit. To determine the effect of a large-scale pharmacist-to-pharmacist TOC model where inpatient clinical pharmacists identify patients during a hospital stay, provide evidence-based care and education, and then coordinate follow-up with an outpatient clinical pharmacist who provided comprehensive medication management (CMM) under a scope of practice. This was a multisite, single health care system, quasi-experimental, matched interrupted time series design study conducted at an integrated Veterans Affairs (VA) health care system. Patients admitted with a primary or secondary diagnosis of diabetes, hypertension, chronic obstructive pulmonary disease (COPD) and heart failure (HF) were included for enrollment. Clinical pharmacists rounding on inpatient medical teams provided evidence-based recommendations to optimize medications while coordinating follow-up by an outpatient clinical pharmacy specialist within 10 days of discharge for CMM. The primary endpoint of this study was to determine the effect on the composite all-cause 30-day acute care utilization rate (emergency department [ED] visit or hospital readmission) for patients discharged with a primary or secondary diagnosis of diabetes, hypertension, COPD, and HF compared with a comparator group of patients with similar discharge diagnosis before implementation of the TOC program. 484 patients (242 in each group, with 366 heart failure, 66 COPD, 10 hypertension, and 42 diabetes) were included for analysis. For the primary outcome of composite 30-day, all-cause acute care utilization rates, no statistically significant difference was identified, with 26.9% of patients in the intervention group and 28.9% in the historical group readmitted or seen in the ED within 30 days of discharge (P = 0.6852). Outcomes for the HF index acute care utilization rate (i.e., admission for the same disease state discharged with), including 30-day index readmissions (P = 0.0014), 30-day index ED visits (P = 0.0047), and 90-day index readmissions for HF (P < 0.0001) were significantly reduced. Our study is one of the first to identify at-risk patients using rounding clinical pharmacists in the acute care arena and coordination of care systematically with a clinical pharmacy specialist practicing under a scope of practice targeted for CMM. Although the overall primary endpoint was not met, a reduction in acute care utilization rates for HF at 30 and 90 days can be achieved. No outside funding supported this research. The authors report no conflicts of interest.

PDB124 BURDEN OF HEART FAILURE IN PATIENTS WITH DIABETES IN ENGLAND

Heart failure (HF) and diabetes independently carry a significant cost to the UK National Health Service (NHS). This may increase among patients with both diseases; HF hospitalisation rates may be higher as prognosis is poor. This cross-sectional study aims to characterise the healthcare burden of comorbid HF and diabetes. We identified patients admitted to hospital in England with a primary diagnosis of HF (ICD-10 Codes I500, I501, I509) and a secondary diagnosis of diabetes (E10-E14) from Hospital Episode Statistics for 3 consecutive years, 2015/16, 2016/17 & 2017/18. We report the total number of inpatient admissions, inpatient costs, 90 day re-admissions, inpatient length of stay, excess bed days, and inpatient mortality. In 2015/16, there were 30,236 inpatient admissions, costing a total of £99,748,586.95. In 2017/18 there were a total of 34,233 admissions costing a total of £127,601,295.77. Inpatient length of stay was 9.94 days in 2014/15 and 9.28 days in 2017/18. This varied across Clinical Commissioning Groups (CCGs) for all three years of observation. 7314 (24%) of the total admissions in 2015/16 were re-admitted within 90 days, this figure was 8,119 (24%) in 2017/18. In 2015/16 there were a total of 20,253 excess bed days across all admissions, in 2017/18 this was 14,930. Of all admissions in 2015/16 approximately 11% resulted in a patient death (N = 3,266), whereas in 2017/18 this was 10% (N = 3,510). Comorbid HF and diabetes pose a high cost to the NHS, with substantial variation within England. 90-day re-admission, excess bed days and inpatient mortality highlight the burden of these conditions. Further research is warranted to understand how hospital-level interventions may contribute to the effort to reduce these costs and improve inpatient mortality.

1252-P: Readmission Risk and Risk Factors of Hospitalizations with a Primary Diagnosis of Diabetes Differ from Discharges with a Secondary Diagnosis of Diabetes

Whether the risk of hospital readmission within 30 days of discharge (early readmission, ER) varies by primary or secondary discharge diagnosis of diabetes (DcDxDM) is unknown. In a retrospective cohort study of adults with diabetes discharged from an academic medical center, we analyzed 4,027 discharges with a primary DcDxDM and 4,027 discharges with a secondary DcDxDM. A total of 49 characteristics were evaluated for association with ER by multivariable logistic regression models. The ER rate of discharges with a primary DcDxDM was significantly higher than the ER rate of discharges with a secondary DcDxDM (22.2% vs. 16.2%, p&amp;lt;0.01). Discharges with a primary DcDxDM were significantly different from discharges with a secondary DcDxDM in 44 characteristics (all p&amp;lt;0.04). Among both primary and secondary DcDxDM discharges, lack of an outpatient visit within 30 days of discharge, length of stay, being unemployed, being discharged within 90 days before admission, and anemia were associated with higher ER risk, and being uninsured was associated with lower ER risk (all p&amp;lt;0.05). Among only primary DcDxDM discharges, lower education, gastroparesis, and higher serum creatinine were associated with higher ER risk, and inpatient diabetes consultation, thiazolidinedione use, and higher hematocrit were associated with lower ER risk (all p&amp;lt;0.02). Among only secondary DcDxDM discharges, urgent/emergent admission, abnormal serum sodium or albumin, discharge against medical advice, and pancreatitis were associated with higher ER risk (all p&amp;lt;0.05). C-statistics for the multivariable models of ER were similar between primary and secondary DcDxDM discharges (0.834 vs. 0.822, p=0.15). Risk factors for ER after a primary DcDxDM discharge differ from risk factors after a secondary DcDxDM discharge. Patients with a primary DcDxDM are at a higher risk of ER and may benefit from dedicated effort to reduce their ER risk. Disclosure D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. H. Zhao: None. E. Miller: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK102963 to D.J.R.)

1556-P: Gender Differences in Glycemic Control, Microvascular and Macrovascular Complications in Hospitalized Patients with Diabetes

Gender differences have been described for glycemic control and prevalence of diabetes related complications in the outpatient setting but have not been examined in the hospitalized population. To address this, we investigated gender differences in demographics, glycemic control and variability (GV), macrovascular and microvascular complications, and admission diagnosis in non-critically ill hospitalized patients with a secondary diagnosis of diabetes recruited for the Readmission and Comprehension of Diabetes Education at Discharge (ReCoDED) Study. To date, 111 men and 87 women have been recruited, with the majority having type 2 DM (86 vs. 79%). Participants age (men vs. women) was 60.6 ± 11.7 vs. 57.6 ± 11.8 years, BMI 32.2 ± 8.4 vs. 32.1 ± 10.6 kg/m2, systolic (SBP) 136 ± 26 vs. 127 ± 23 mmHg, diastolic (DBP) 77 ± 13 vs. 75 ± 14 mmHg, HbA1c 8.0 ± 2.3 vs. 8.3% ± 2.5%, and DM duration 14.5 ± 10.4 vs. 14.1 ± 11.6 years. Race, education, and employment were similar. Men had more retinopathy (23 vs. 16%) and nephropathy (40 vs. 28%), but not neuropathy (60 vs. 63%). Women had a lower prevalence of CAD (49 vs. 36%), but a similar prevalence of CHF (37 vs. 37%), stroke (15 vs. 18%), and PVD (18 vs. 17%). The most frequent admission diagnoses were CVD (37 vs. 22%) and infection (10 vs. 19%). Mean blood glucose (BG) (198 ± 51 vs. 200 ± 54 mg/dl), GV (177 ± 80 vs. 182 ± 112 mg/dl), frequency of hypoglycemia (BG &amp;lt; 70 mg/dl) and hyperglycemia (BG &amp;gt;250 mg/dl) were similar in the 48 hours prior to discharge. Length of stay was 7.8 ± 6.9 vs. 8.3 ± 7.4 days. In summary, this gender-based description of glycemic control and prevalence of diabetes-related complications in an inpatient population demonstrates that hospitalized women with DM have fewer microvascular complications, a lower prevalence of CAD but a similar prevalence of CHF, stroke and PVD when compared to men, despite similar BMI and DM duration. These findings will be examined as a risk factor for hospital readmissions in this ongoing study. Disclosure N. Patel: None. D. Pinkhasova: None. A. Donihi: None. E. Karslioglu French: None. L.M. Siminerio: None. K. Delisi: None. D.S. Hlasnik: None. M.T. Korytkowski: None.

Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes.

Medical professionals and laypeople alike understand the fact that people with diabetes are at increased risk for serious medical complications such as cardiovascular disease, kidney disease, peripheral neuropathy, and lower extremity amputations.1 However, I have observed that many people, including people with diabetes and the rehabilitation health providers treating them, are not aware of a large body of evidence linking diabetes with increased risk for numerous musculoskeletal impairments and complications.2 These impairments are apparent in type 1 diabetes (due to beta cell destruction, usually leading to absolute insulin deficiency) and type 2 diabetes (due to progressive loss of insulin secretion on the background of insulin resistance). The purpose of this point of view is to highlight the musculoskeletal impairments that are exacerbated, or potentially even caused, by metabolic disorders associated with diabetes. This article will focus on those musculoskeletal impairments most often encountered by physical therapists and other rehabilitation practitioners, describe the systemic condition of limited joint mobility, and briefly outline a likely mechanism for musculoskeletal impairments. Finally, the article will briefly provide clinical and research implications for those in rehabilitation working with this population. Metabolic dysfunctions clearly leave people with diabetes at high risk for developing musculoskeletal pain and impairments. In a large Danish study that compared patients with type 2 diabetes (n=951) directly with age-, sex-, and region-matched control participants (n=22,923), the patients with diabetes were 1.7 to 2.1 times more likely to report musculoskeletal pain compared with those without diabetes.3 Consistent with this high risk for musculoskeletal disorders, the group with diabetes reported high incidences of shoulder or neck pain (52%); low back pain (60%); and arm, hand, knee, or hip pain (71%).3 Furthermore, people pursuing physical therapy for musculoskeletal pain and impairments often have a secondary diagnosis of diabetes or have risk …

Diabetes as an increasingly common comorbidity among patient hospitalizations for tuberculosis in the USA.

ObjectiveDiabetes is a risk factor for active tuberculosis (TB). The purpose of this paper was to estimate the risk of hospitalization for TB with and without a secondary diagnosis of diabetes in groups with different ethnic backgrounds.Research design and methodsWe used the Nationwide Inpatient Sample from 1998 to 2011, identifying all patients with a primary diagnosis of TB and/or a secondary diagnosis of diabetes (type 1 or type 2) or HIV. Next, we performed logistic regression to investigate the association of diabetes status, HIV status, and race (and the interaction of diabetes and race) with the risk of hospitalization with a primary diagnosis of TB. We also included a time covariate, to determine whether potential risk factors changed during the study period.ResultsControlling for HIV status, diabetes did not increase the odds of TB in white and black patients. However, in Hispanic and Asian/Pacific Islander patients, diabetes increased the odds of TB by a factor of 1.7 (95% CI 1.51 to 1.83). Asian/Pacific Islanders who had diabetes but not HIV experienced 26.4 (95% CI 23.1 to 30.1) times the odds of TB relative to the white males without diabetes or HIV. In addition, the percent of TB cases that belong to these high-risk groups (Asian/Pacific Islander/Hispanic diabetics) has more than doubled from 4.6% in 1998 to 9.6% in 2011.ConclusionsIn specific demographic groups, diabetes was a strong risk factor for hospital admissions for TB.

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

ObjectiveTo evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after...

Retrospective cohort study evaluating the incidence of diabetic foot infections among hospitalized adults with diabetes in the United States from 1996-2010

The prevalence of diabetes has increased over the last 2decades; however, the national incidence of diabetic foot infections (DFIs) in the United States is unknown. We sought to determine national trends in DFIs among hospitalized adults in the United States over 15years. This was a retrospective cohort study of the U.S. National Hospital Discharge Survey from 1996-2010. Adult patients with a principal diagnosis of foot infection and a secondary diagnosis of diabetes were identified using ICD-9-CM codes. Incidence was defined as DFI discharges per 100 diabetes discharges. Independent risk factors for DFI among diabetics were identified using multivariable logistic regression. These data represent 1,059,552 DFI discharges over the study period. The incidence of DFI decreased from 1996 (2.3 DFIs/100 diabetes discharges) to 2010 (1.1 DFI/100 diabetes discharges). The proportion of patients experiencing lower-extremity amputation declined from 33.2% in 1996 to 17.1% in 2010. Peripheral vascular disease (odds ratio [OR], 2.89; 95% confidence interval [CI], 2.87-2.91), peripheral neuropathy (OR, 2.62; 95% CI, 2.60-2.64), and male sex (OR, 1.67; 95% CI, 1.66-1.68) were the leading risk factors for DFI. The incidence of DFI among hospitalized adults in the United States declined by more than half from 1996-2010.

Frequency of Hypoglycemia and its Impact on Length of Stay, Mortality, and Short-Term Readmission in Patients with Diabetes Hospitalized In Internal Medicine Wards

To evaluate whether hypoglycemia is associated with increases in length of stay (LOS), inpatient mortality, and readmission among patients with diabetes hospitalized in internal medicine wards. A retrospective cohort study was carried out using the Basic Minimum Data Set registry of the Spanish National Health System, which contains clinical and administrative information for every patient discharged from system hospitals. The analysis included patients discharged between January 2005 and December 2010 and had a primary (i.e., reason for the admission) or secondary diagnosis of diabetes and a secondary diagnosis of hypoglycemia. The associations between hypoglycemia and the study outcomes (mortality, readmission, and LOS) were evaluated using multivariate and multilinear regression models that included age, sex, and the Charlson index as covariates. During the study period, 3,361,104 patients were admitted to internal medicine wards in the National Health System. Of these, 921,306 (27.4%) had diagnoses of diabetes, and among these patients, 46,408 (5%) had secondary hypoglycemia. A total of 4,754 (10.2%) patients with secondary hypoglycemia died during their hospital stays, compared with 83,508 (9.5%) patients without hypoglycemia. The multivariate/multilinear regression models demonstrated significant associations between the presence of secondary hypoglycemia and greater inpatient mortality (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.20-1.28), a greater likelihood of readmission (OR 1.20, 95% CI 1.17-1.23), and an increased LOS (β 1.24, 95% CI 1.15-1.35). Hypoglycemia in patients with diabetes hospitalized in internal medicine wards is associated with increases in the LOS, inpatient mortality, and early readmission.

Prevalence of diabetes in patients with major depressive disorder: a population-based study

ObjectiveWe conducted this population-based study to detect the prevalence and associated factors of diabetes in patients with major depressive disorder (MDD) in Taiwan. MethodsThe National Health Research Institute provided a database of 1 000 000 random subjects for health service study. We obtained a random sample of 766 427 subjects 18 years or older, in 2005. Study subjects who had at least one service claim during 2005 for either outpatient or inpatient care, with a primary diagnosis of MDD or with a primary or secondary diagnosis of diabetes, were identified. ResultsThe 1-year prevalence of diabetes in patients with MDD was higher than that in the general population (11.65% vs 6.53%; odds ratio, 1.53; 95% confidence interval, 1.39-1.69) in 2005. Compared with the general population, patients with MDD had a higher prevalence of diabetes in all age groups, except age 18 to 29 years; among men and women; among all insurance amount groups; among those living in the northern and southern regions; and among residents living in urban, suburban, and rural areas. A higher prevalence of diabetes in patients with MDD was associated with increased age, use of antipsychotic agents, use of mood stabilizers, and residence in suburban areas. ConclusionsPatients with MDD had a much higher prevalence of diabetes in young adult age group and in men than in the general population. Consequently, we must emphasize prevention, early detection, and adequate treatment of diabetes in patients with MDD.

Age and Sex Differences in Hospitalizations Associated with Diabetes

To evaluate national trends in hospitalizations and hospital charges associated with diabetes over a recent 14-year period. We evaluated hospital discharges with a primary or secondary diagnosis of diabetes (250.xx)in the Nationwide Inpatient Sample (1993-2006). Outcomes included population-adjusted estimates of hospital discharges and hospital charges (2006 $U.S.). Overall, discharges associated with diabetes increased 65.3% (1,384/100,000 in 1993, 2,288/100,000 in 2006) over the 14-year period (p < 0.001 test for trend). The largest increase in hospitalizations occurred among adults 30-39 years of age, representing a 102% increase. Among young adults, increases among women were ∼1.3 times greater compared with men, for the 20-29 year (63% vs. 46%) and 30-39 year (118% vs. 85%) age groups, even after excluding pregnancy-related hospitalizations. Overall, women had higher rates of hospitalizations associated with diabetes compared with men, but there was evidence of an age by sex interaction, with higher rates of hospitalizations among women in the younger age groups and among men in the older age groups. Annual inflation-adjusted total charges for hospitalizations with diabetes increased 220% over the period. Large increases in diabetes hospitalizations occurring among adults aged 30-39 years and young women signal a shift in the hospital burden of diabetes.

Glycemic Control and Use of the Insulin Sliding Scale in Hospitalized Patients with Diabetes

This study assessed the extent of use of the subcutaneous insulin sliding scale (ISS) with hospitalized medical patients and examined the association between ISS use and glucose control. Despite some concerns about efficacy and suitability, the ISS is often used in the hospital studied. Researchers reviewed records of patients with a secondary diagnosis of diabetes who were admitted to the medical teaching unit of a tertiary care hospital. On day 1, 45.2% of patients were on an ISS alone. Patients on an ISS were more likely to experience hyperglycemia compared with patients on scheduled regimens, but they also had fewer hypoglycemic episodes.