title: Temporal trend in hospitalizations for acute diabetic complications: a nationwide study, Italy, 2001-2010.
abstract: BACKGROUND
  We investigated temporal trends and geographic variations in both hospitalizations and in-hospital mortality rates for acute diabetic complications (ADC) in the Italian universal health care system.
  
  
  RESULTS
  A retrospective review of the medical records of patients with either primary or secondary discharge diagnosis of hyperglycaemic acute complications (ICD-9-CM codes 250.1, 250.2, 250.3) or hypoglycemic coma (ICD-9-CM code 251.0) was performed in period 2001-2010. Standardized rates by age and gender on 2001 Italian population and by diabetic population were calculated. We identified 7,601.883 diabetes-related hospital discharges. Out of them, 266,374 (3.5%) were due to ADC, either ketoacidosis/hyperosmolarity (94.4%) or hypoglycemic coma (5.6%). The rate of discharge for ADC decreased by 51.1% from 2001 to 2010 (14.4 vs. 7.1 discharge rate/1,000 diabetic people; 5.7% decrease per year, test for trend, p<0.001) with a similar trend for both hyperglycemic and hypoglycemic complications. Diabetic people in the younger age groups (≤ 19 and 20-44 years old) had a significantly greater rate of discharge for ADC than people aged 65 years and over (≤ 19 10-fold increase; 20-44: 2-fold increase). In-hospital mortality rate was 7.6%, with 211 preventable deaths in younger diabetic people (≤ 44 years old). There was a large variability among Italian Regions and the ratio between the highest and the lowest regional discharge rate reached 300% in 2010.
  
  
  CONCLUSIONS
  Decreasing temporal trend in hospitalizations for preventable ADC suggests improving outpatient care. In younger diabetic patients, however, both hospitalization rates and in-hospital mortality are still a matter of concern.
authors.affiliation: National Institute of Health, Rome, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Lombardo
authors.forename: Marina
authors.initials: M
authors.lastname: Maggini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gruden
authors.forename: Graziella
authors.initials: G
authors.lastname: Bruno
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult