Factors influencing hospitalization or emergency department visits and mortality in type 2 diabetes following the onset of new cardiovascular diagnoses in a population-based study
Open accessAbstract
Background: Individuals with type 2 diabetes (T2D) are at increased risk of developing cardiovascular disease (CVD) which necessitates monitoring of risk factors and appropriate pharmacotherapy. This study aimed to identify factors predicting emergency department visits, hospitalizations, and mortality among T2D patients after being newly diagnosed with CVD. Methods: In a retrospective observational study conducted in Region Halland, individuals aged > 40 years with T2D diagnosed between 2011 and 2019, and a new diagnosis of CVD between 2016 and 2019, were followed for one year from the date of CVD diagnosis. The first encounter for CVD diagnosis was categorized as inpatient-, outpatient-, primary-, or emergency department care. Follow-up included laboratory tests, blood pressure, pharmacotherapies, and healthcare utilization. Hazard ratios (HR) in two Cox regression analyses determined relative risks for emergency visits/hospitalization and mortality, adjusting for age, sex, glucose regulation, lipid levels, kidney function, blood pressure, pharmacotherapy, and healthcare utilization. Results: The study included a total of 1759 T2D individuals who received a new CVD diagnosis, with 67% diagnosed during inpatient care. The average hospitalization stay was 6.5 days, and primary care follow-up averaged 10.1 visits. Patients with CVD diagnosed in primary care had a HR 0.52 (confidence interval [CI] 0.35–0.77) for emergency department visits/hospitalization, but age had a HR 1.02 (CI 1.00-1.03). Pharmacotherapy with insulin, DPP4-inhibitors, aldosterone antagonists, and beta-blockers had a raised HR. Highest mortality risk was observed when CVD was diagnosed inpatient care, systolic blood pressure < 100 mm Hg and elevated HbA1c. Age had a HR 1.05 (CI 1.03–1.08), eGFR < 30 ml/min HR 1.46 (CI 1.01–2.11), and LDL-Cholesterol > 2,5 h 1.46 (CI 1.01–2.11) and associated with increased mortality risk. Pharmacotherapy with metformin had a HR 0.41 (CI 0.28–0.62), statins a HR 0.39 (CI 0.27–0.57), and a primary care follow-up < 30 days a HR 0.53 (CI 0.37–0.77) and associated with lower mortality risk. Conclusions: T2D individuals who had a new diagnosis of CVD were predominantly diagnosed when hospitalized, while follow-up typically occurred in primary care. Identifying factors that predict risks of mortality and hospitalization should be a focus of follow-up care, underscoring the critical role of primary care in the effective management of T2D and CVD.
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Patients with diabetes are at higher risk of hospital admissions and frequent ED visits, driven by comorbidities such as heart failure, chronic kidney disease, and poor glycemic control.
“Patients with diabetes are at higher risk of hospital admissions and frequent emergency department (ED) visits [2], driven by comorbidities such as heart failure, chronic kidney disease, and poor glycemic control [3].”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [3]
The Discussion (page unavailable) reports a higher hospitalization risk for people with both type 2 diabetes and cardiovascular disease, and higher hospitalization and ED-visit risk for the subgroup whose cardiovascular disease was diagnosed in the ED. It does not establish the broader claim that patients with diabetes generally have more hospital admissions or frequent ED visits. The comorbidity explanation is attached to citation [3], not this source. (LLM, conf=0.83)
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- Authors
- Agvall, B., Jonasson, J. M., Galozy, A., & Halling, A.
- Affiliations
- Lund University (SE)
- Region Halland (SE)
- Halmstad University (SE)
- Corresponding author
- Agvall, Björn
- Venue
- Cardiovascular Diabetology
- Published
- 2024-04-10
- Volume
- 23
- Issue
- 1
- Pages
- 124-124
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC11007935
- OpenAlex
- W4394690192
- Cited by
- 10
- References
- 26
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 1
- FWCI
- 3.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Lund University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, cardiovascular disease, hospitalization, emergency department visits, mortality, risk factors, metformin, statins, insulin, DPP-4 inhibitors, mineralocorticoid receptor antagonists, beta-blockers, HbA1c, systolic blood pressure, estimated glomerular filtration rate, LDL cholesterol, primary care, inpatient diagnosis, health care utilization, risk stratification
- MeSH terms
- Emergency Room Visits, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Hospitalization, Humans, Risk Factors
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