Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
The Costs Of Diabetes

Trends in Diabetes-Related Preventable Hospitalizations in the U.S., 2005–2014

  1. Muni Rubens1,
  2. Anshul Saxena2,
  3. Venkataraghavan Ramamoorthy3,
  4. Rohan Khera4,
  5. Jonathan Hong5,
  6. Emir Veledar2 and
  7. Khurram Nasir2,6,7,8,9⇑
  1. 1Miami Cancer Institute, Baptist Health South Florida, Miami, FL
  2. 2Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
  3. 3Department of Nutrition and Kinesiology, University of Central Missouri, Warrensburg, MO
  4. 4Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
  5. 5Division of Cardiovascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
  6. 6Herbert Wertheim College of Medicine, Florida International University, Miami, FL
  7. 7Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL
  8. 8Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
  9. 9Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University, Baltimore, MD
  1. Corresponding author: Khurram Nasir, khurramn{at}baptisthealth.net.
Diabetes Care 2018 May; 41(5): e72-e73. https://doi.org/10.2337/dc17-1942
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading

Diabetes-related preventable hospitalizations are indicators of effective primary care services (1), but recent trends are unknown. Hence, we examined the trends in diabetes-related preventable hospitalizations to critically inform policy decisions seeking accountability.

The current study used National (Nationwide) Inpatient Sample (NIS) data for assessing the trends in diabetes-related ;preventable hospitalization rates during the years 2005–2014. The NIS collected stratified samples of ∼20% of U.S. community hospital discharge data, which has been useful in calculating national estimates (2). The main outcomes included temporal trends in diabetes-related preventable hospitalization rates and associated conditions such as diabetes short-term complications, diabetes long-term complications, uncontrolled diabetes, lower-extremity amputations, and hospitalization costs. Yearly rates were calculated by dividing diabetes-related preventable hospitalizations and four diabetes-related Prevention Quality Indicators conditions by estimated number of adults aged ≥18 years with diagnosed diabetes obtained from National Health Interview Survey (NHIS) data.

A total of 5,399,199 diabetes-related preventable hospitalizations were reported as primary discharge diagnosis during the years 2005–2014. Diabetes-related preventable hospitalizations increased from 500,444 in 2005 to 577,040 in 2014. Age-adjusted diabetes-related preventable hospitalization rates did not change significantly during the study period (Ptrend = 0.279) (Fig. 1A). Diabetes-related preventable hospitalization rates decreased across all age-groups, except for an increase in the age-group 18–44 years, which was not significant (relative increase 20.5%; Ptrend = 0.052). The overall diabetes-related preventable hospitalization rates showed an annual percentage change of 1.0% (95% CI −0.9, 2.9; P = 0.300).

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1

Diabetes-related preventable hospitalization rates, 2005–2014.

Age-adjusted hospitalization rates due to diabetes short-term complications increased significantly (relative increase 30.3%; Ptrend = 0.003) while those due to uncontrolled diabetes decreased significantly (relative increase 68.4%; Ptrend <0.001) (Fig. 1B). Hospitalization rates due to diabetes short-term complications increased across all age-groups, except for a nonsignificant decrease in the age-group ≥75 years (relative decrease 10.00%; Ptrend = 0.838). Hospitalization rates due to uncontrolled diabetes significantly decreased in all age-groups.

The mean length of stay decreased significantly from 5.7 to 5.3 days during the years 2005–2014 (relative decrease 7.5%; Ptrend <0.001). The total cost of hospitalizations due to diabetes-related preventable causes significantly increased from $5.32 to $6.28 billion during the study period (Ptrend = 0.042); however, mean hospitalization cost decreased significantly from $12,080 to $11,440 (Ptrend = 0.017).

Our study found that diabetes-related preventable hospitalization rates did not change significantly during the years 2005–2014, unlike the results in a previous study (3) that reported significantly decreasing trends. This could probably be due to a slight increase in hospitalization rates due to diabetes short-term complications balanced by a slight decrease in hospitalization rates due to uncontrolled diabetes. More importantly, we noted a significant increase in diabetes-related preventable hospitalizations due to acute complications in the age-group 18–44 years. Future interventions should focus on adequate management strategies in younger patients (18–44 years) because earlier control over the risk factors for microvascular and macrovascular processes could delay complications (4,5) and significantly decrease the prevalence of hospitalizations in this age-group. Further studies are needed to identify the underlying determinants of these trends so that primary care can focus on effective strategies to address these continuing challenges.

Article Information

Acknowledgments. The authors thank the millions of patients who contributed to the NIS database and the numerous professionals who created the database.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Author Contributions. M.R. conceived the idea, and M.R., A.S., and V.R. wrote and edited the manuscript. R.K., J.H., and K.N. reviewed and edited the manuscript and contributed to the intellectual content. E.V. reviewed statistical analyses and edited the manuscript. M.R. and A.S. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Footnotes

  • M.R. and A.S. are co–first authors.

  • See accompanying articles, pp. 917, 929, 933, 940, 949, 956, 963, 971, 979, and 985.

  • Received September 17, 2017.
  • Accepted December 31, 2017.
  • © 2018 by the American Diabetes Association.
http://www.diabetesjournals.org/content/license

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

References

  1. ↵
    1. Agency for Healthcare Research and Quality
    . AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Rockville, MD, 2001
  2. ↵
    1. Healthcare Cost and Utilization Project (HCUP)
    . Overview of the National (Nationwide) Inpatient Sample (NIS) [article online], 2017. Available from https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 28 August 2017
  3. ↵
    1. Wang J,
    2. Imai K,
    3. Engelgau MM,
    4. Geiss LS,
    5. Wen C,
    6. Zhang P
    . Secular trends in diabetes-related preventable hospitalizations in the United States, 1998–2006. Diabetes Care 2009;32:1213–1217
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Holman RR,
    2. Paul SK,
    3. Bethel MA,
    4. Matthews DR,
    5. Neil HAW
    . 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577–1589
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    1. Nathan DM,
    2. Cleary PA,
    3. Backlund JY, et al.; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group
    . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643–2653
    OpenUrlCrossRefPubMedWeb of Science
PreviousNext
Back to top
Diabetes Care: 41 (5)

In this Issue

May 2018, 41(5)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Trends in Diabetes-Related Preventable Hospitalizations in the U.S., 2005–2014
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Trends in Diabetes-Related Preventable Hospitalizations in the U.S., 2005–2014
Muni Rubens, Anshul Saxena, Venkataraghavan Ramamoorthy, Rohan Khera, Jonathan Hong, Emir Veledar, Khurram Nasir
Diabetes Care May 2018, 41 (5) e72-e73; DOI: 10.2337/dc17-1942

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Trends in Diabetes-Related Preventable Hospitalizations in the U.S., 2005–2014
Muni Rubens, Anshul Saxena, Venkataraghavan Ramamoorthy, Rohan Khera, Jonathan Hong, Emir Veledar, Khurram Nasir
Diabetes Care May 2018, 41 (5) e72-e73; DOI: 10.2337/dc17-1942
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Article Information
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Unstable Housing and Diabetes-Related Emergency Department Visits and Hospitalization: A Nationally Representative Study of Safety-Net Clinic Patients
  • Health Care Costs Associated With Incident Complications in Patients With Type 2 Diabetes in Germany
Show more The Costs Of Diabetes

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.