The Rise of Diabetes in Massachusetts Emergency Departments

To examine trends in diabetes-related visits to emergency departments (EDs) across the state of Massachusetts. This study used data from the Division of Health Care Finance and Policy's newly created Outpatient Emergency Department Database. Patients who were given a principal diagnosis of either type 1 or type 2 diabetes during an emergency department (ED) visit at a Massachusetts hospital between January 1, 2000, and September 30, 2002, were included in the analysis. Diagnosis trends were examined based on age, gender, race, and expected payer source for both type 1 and type 2 diabetes. In addition, the average cost for a diabetes-related visit was compared with a nondiabetic visit cost. Between fiscal years 2000 and 2002, the total number of outpatient ED visits in Massachusetts increased by 7%, yet the number of ED visits with diabetes as the principal diagnosis increased by 22%. The most profound impact on EDs has been the increasing number of patients with type 2 diabetes. During the 3-year analysis period, type 2 diabetes increased by more than 30% in every age group, with a shocking 65.0% increase among adolescents aged 15 to 24 years. A disproportionate representation by racial minorities was seen among ED patients. In 2002, for every 1000 black residents of Massachusetts, 4.5 ED diabetes visits were made, compared with 2.2 visits/1000 Hispanics and 1.2 visits/1000 whites. The cost of diabetes care in the ED is also of concern. In 2002, the mean charge of an ED outpatient diabetes-related visit was substantially higher than the average ED visit charge for a patient without diabetes ($911 vs. $807 at a teaching hospital). Diabetes is a serious condition that is manifesting itself in epidemic proportions. The rapid increase in diabetes-related ED visits is of serious concern and may indicate that increasing financial or other barriers to adequate primary care are driving the escalation in ED visits by diabetics.