Diabetes Prevalence Increasing Among Patients Who Visit the Emergency Department

The prevalence of adult-onset diabetes mellitus (DM) is increasing in patients seeking care in the emergency department (ED), according to the results of a new study. The increase appears to be influenced by the obesity level of the patient and by patient age.

National and state data on the prevalence of DM are based largely on telephone interviews, a national survey, or ED discharge diagnoses. University of Mississippi Medical Center researchers conducted a study focused on patients seeking care in the ED for any reason.

“Our approach allowed for a potentially less biased and more accurate interpretation of the prevalence of DM and the factors that could impact its prevalence. Some recent research shows that the increase in obesity has leveled off. Our research shows that DM continues to increase proportional to established obesity,” Sarah Sterling, MD, Instructor, and Robert Cox, MD, PhD, Professor, both of the Emergency Medicine Department, at the University of Mississippi Medical Center, told ConsultantLive.

The data show not only a steady increase in ED visits by patients with DM, but also a steady increase in the prevalence of patients with DM.

The study examined the longitudinal trends in DM in ED patients and evaluated the factors that impacted those trends. The researchers documented the presence of DM, height, and weight among all patients older than 16 years who presented to the ED between 2006 and 2011. This university-based teaching hospital averaged a yearly volume of 57,000 to 70,000 patients over the 6-year study.

About three-quarters of the patient population were African American, and about one-quarter were Caucasian. Data were analyzed in 1-year blocks then examined for trends using linear regression analysis. The data were also examined by obesity class based on body mass index (BMI), normal weight (BMI 20 to 24.9 mg/kg²), overweight (BMI 25 to 29.9 mg/kg²), obese (BMI 30 to 34.9 mg/kg²), and extreme obesity (BMI > 40 mg/kg²).

The researchers found “a strong positive trend showing increasing prevalence of adult-onset diabetes mellitus over the study period,” Dr Sterling said. The percentage of patients with adult-onset DM increased from 8.4% to 12.5%. No changes in the percentage of juvenile-onset DM were seen over the study period, she noted.

“Progressive increases in yearly adult-onset DM prevalence were observed for all BMI classes. The rate of change in the increase of DM was directly related to the degree of obesity,” said Dr Sterling. For the extreme obesity category, the percentage of patients with DM increased 1.4% per year, obesity 1.0% per year, overweight 0.7% per year, and normal weight 0.5% per year. The absolute change in the percentage of DM in those with extreme obesity ranged from 18.4% to 24.9%. The patient age increased slightly for all obesity groups, accounting for a 0.2% to 0.4% per year increase in the prevalence of DM in the population.

Drs Sterling and Cox note that since this study was performed in one of the states with the highest obesity rates in the country, these results may not be applicable to EDs in other areas.

“The study highlights the importance of weight control and suggests that primary care physicians can impact their patients by counseling them on weight management and loss. In addition, our results suggest that even normal weight patients may be at a small increased risk for developing DM,” she said. “This highlights the importance of healthy eating and intake regardless of weight class, another area where primary care physicians can play an important role in counseling and health maintenance as well as general health screenings. Primary care physicians may see a similar increase in DM prevalence, with extremely obese and aging patients being at the highest risk.”

Dr Cox presented the results of the study on October 14, 2013, at the American College of Emergency Physicians annual meeting.