Risk Factors for Hyperglycemic Emergency Department Visits in Newly Diagnosed Type 2 Diabetes: History of Depression as a Key Predictor

Abstract

Aims: To identify risk factors for hyperglycemia in emergency department visits within 1 year following type 2 diabetes diagnosis. Methods: In this retrospective cohort study, electronic medical record data from 3333 adult patients newly diagnosed with type 2 diabetes across 57 primary care clinics in West Michigan between April 2021 and January 2023 were analyzed. The primary outcome was hyperglycemia at ED encounters within 12 months of diagnosis. General linear/Cox regression models were used to identify risk factors, adjusting for demographics, clinical characteristics, and medications. Results: Of 3333 patients (mean age 61.8 years, 56.9% male), 68 (2.0%) experienced hyperglycemia-related ED visits during follow-up. Key risk factors included history of depression (aOR 3.01, 95% CI 1.64-5.52, P < .001), and higher initial HbA1c values (aOR 1.74 per percentage point increase, 95% CI 1.49-2.02, P < .001). Protective factors included metformin (aOR 0.21, 95% CI 0.11-0.39, P < 0.001) and sulfonylureas (aOR 0.11, 95% CI 0.02-0.53, P = .006) prescriptions. Other clinical and demographic factors showed no statistically significant associations. Conclusions: A history of depression emerged as a risk factor for hyperglycemia in emergency department visits following type 2 diabetes diagnosis. These findings emphasize the particular importance of addressing psychological distress in diabetes care during the vulnerable post-diagnosis period.