Predictors of 30-Day Recurrent Emergency Department Visits for Hyperglycemia in Patients With Diabetes: A Multicentre Prospective Cohort Study.

Objectives: Identifying predictors of increased healthcare utilization for hyperglycemia may have important implications for designing interventions to improve patient outcomes and reduce costs. Studies examining predictors of 30-day recurrent ED hyperglycemia visits have been limited due to their retrospective nature. This study's objective was to prospectively identify predictors of 30-day recurrent ED visits for hyperglycemia in patients with diabetes.

Methods: We conducted a multicentre, prospective cohort study of adults ≥ 18 years at one of four Canadian tertiary care, academic EDs with a diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Multivariable logistic regression analysis was used to identify variables independently associated with recurrent 30-day ED visits for hyperglycemia.

Results: We enrolled 594 patients; 80 (13.5%) had a recurrent ED visit for hyperglycemia within 30 days. Independently associated predictors of 30-day recurrent visits on complete case analysis include substance abuse history (odds ratio [OR] 2.32, 95% confidence interval [CI]: 1.23-4.38) and initial laboratory blood glucose (OR 1.04, 95% CI: 1.01-1.07), while a new diabetes diagnosis was negatively associated (OR 0.29, 95% CI: 0.09-0.94). Sensitivity analysis using multiple imputation for missing data found the following independently associated variables: substance abuse history (OR 2.55, 95% CI: 1.34-4.85), previous ED visit within the past 14 days (OR 2.14, 95% CI: 1.02-4.48), and initial laboratory blood glucose (OR 1.04, 95% CI: 1.01-1.07). Two variables were negatively associated: recent hospitalization within the past 30 days (OR 0.40, 95% CI: 0.19-0.98) and new diabetes diagnosis (OR 0.37, 95% CI: 0.14-0.97).

Conclusions: This multicentre prospective study reports predictors independently associated with 30-day recurrent ED visits for hyperglycemia. These predictors should be considered by ED clinicians when making disposition and follow-up plans for this important patient population, and future interventions should explore the interaction between hyperglycemia and substance use to prevent recurrent ED visits and reduce healthcare system costs and utilization.