title: Association between diabetic ketoacidosis hospitalizations and driving distance to outpatient diabetes centres in adults with type 1 diabetes mellitus.
abstract: OBJECTIVE
  The purpose of this study was to assess the relationship between diabetic ketoacidosis (DKA) hospitalization and driving distance from home to outpatient diabetes care in adults with type 1 diabetes mellitus.
  
  
  METHODS
  We identified adults with type 1 diabetes using clinical and administrative databases living in Calgary, Alberta. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes were used to identify DKA hospitalizations, and geographic information systems were used to obtain road distance. Multivariate logistic regression was used to assess the association between driving distance (exposure) to diabetes care sites and the outcome of DKA hospitalization.
  
  
  RESULTS
  We identified 1467 patients (151 patients with DKA) with type 1 diabetes. Patients with DKA hospitalizations were younger (35.6 vs. 41.0 years), had shorter duration of diabetes (13.6 vs. 18.7 years) and higher glycated hemoglobin (9.2% vs. 8.4%). Driving distance from home to diabetes centre 1 (adjusted odds ratio 1.02 per 1 km; 95% confidence interval, 0.96 to 1.07), diabetes centre 2 (adjusted odds ratio 1.01; 95% confidence interval, 0.99 to 1.04) or closest general practitioner (adjusted odds ratio 0.9; 95% confidence interval, 0.63 to 1.25) was not associated with DKA hospitalization. Driving distance was also not associated with glycemic control.
  
  
  CONCLUSIONS
  Within a large urban city, driving distance to diabetes centres does not appear to be protective of DKA hospitalization. However, this work does not preclude the role of local travel distance and diabetes outcomes. More research is required to explore the role of other individual, neighbourhood and community factors that influence DKA hospitalization.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: sbutalia@ucalgary.ca.
authors.forename: Sonia
authors.initials: S
authors.lastname: Butalia
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alka B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Doreen M
authors.initials: DM
authors.lastname: Rabi
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D001334:Automobile Driving / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013997:Time Factors; D055815:Young Adult
keywords: acidocétose diabétique; centres de diabète; diabetes centres; diabetic ketoacidosis; diabète de type 1; distance routière; driving distance; type 1 diabetes