Abstract
Aims
There is limited information characterizing young adults (18–35 years) (YA) with diabetes,
especially those admitted for hyperglycemic emergencies. The study aims were to examine
associations of patient-level characteristics with hyperglycemic emergency hospitalization
and to identify variations based on diabetes type and glycemic control.
Methods
We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with
diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS).
T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes
history, clinical indicators, complications/comorbidities, and hospital admission
stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol),
≥9% to 12% (108 mmol/mol), ≥12%).
Results
Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main
DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset
type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized
within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric
co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had
insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c
≥12% were more likely to be Black and lack insurance.
Conclusions
YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled
diabetes. Many already had comorbidities and diabetes complications, high use of acute
care services and low use of diabetes specialty services. YA characteristics varied
by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially
impacting healthcare utilization patterns and medication adherence, and leading to
DKA/HHS admissions.
Keywords
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Article info
Publication history
Published online: September 24, 2019
Accepted:
September 23,
2019
Received in revised form:
August 18,
2019
Received:
June 6,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
