We quantified, among diabetic adults, the frequency, costs, and factors associated with visits to the\nemergency department (EDs) and subsequent hospitalizations for acute hypoglycaemic and hyperglycaemic events.\nMethods: We included adults with diabetes residing in the Milan Agency for Health Protection between 2015 and\n2017. From healthcare databases, we identified demographic variables, comorbidities, type of treatment, insulin\ntreatment duration, previous ED attendances for acute glycaemic events, and two indicators of glycaemic\nmonitoring. Using a validated ICD-9-CM coding algorithm, we identified all ED attendances for acute glycaemic\nevents from the ED database and calculated their incidence. We computed the direct costs from health databases\nand presented them as average annual mean costs for those having had at least an ED attendance. The analysis of\nthe association between the number of ED attendances and potential determinants was performed using zeroinflated\nnegative binomial regression models. These two-part models concomitantly estimate two sets of\nparameters: the odds-ratios (ORs) of having no attendances and the incidence rate ratios (IRRs) of attendance.\nResults: The cohort included 168,285 subjects, 70% of subjects were older than 64 years, 56% were males, and 26%\nwere treated with insulin. The incidence of acute glycaemic events for those attending the ED was 7.0 per 1000\npatient-years, followed by hospitalization 26.0% of the time. The total annual direct cost for ED attendances due to\nacute glycaemic events was 174,000 â?¬. Type of antidiabetic treatment had the strongest association with ED\nattendances for hypoglycaemia. Patients assuming insulin only had a lower probability of having no attendances (OR..................
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