Date of Award
Fall 9-19-2025
Document Type
Open Access Thesis
Degree Name
Master of Medical Science (MMSc)
First Advisor
Jorge Moreno, MD
Abstract
Background: Hyperglycemia-related emergency department visits represent a serious and costly complication for individuals with type 2 diabetes. While metformin is the most commonly prescribed first-line medication, many patients require additional antihyperglycemic therapy. The effect of these combination therapies on emergency care for hyperglycemia remains uncertain.
Objective: To examine whether different antihyperglycemics combined with metformin affect the incidence rate of hyperglycemic-related emergency department visits compared to metformin monotherapy, and to explore effects on recurrence and all-cause mortality.
Methods: We conducted a retrospective cohort study of adults with type 2 diabetes in the Yale New Haven Health System from January 1, 2020, through December 31, 2023. Patients were categorized into five groups based on their home antihyperglycemic regimen during their initial hyperglycemic-related emergency department visit. Negative binomial regression assessed the primary outcome of hyperglycemia-related visit incidence rates. Logistic regression examined the secondary outcomes of recurrence and all-cause mortality
Results: A total of 472 patients were included. No statistically significant differences in hyperglycemic-related emergency department incidence rates were found between any metformin-antihyperglycemic combination therapy and metformin monotherapy. Depression was associated with a 24% higher incidence rate and 157% higher odds of recurrence. Metformin combined with a sodium-glucose cotransporter 2 inhibitor was associated with 83% lower odds in all-cause mortality compared to metformin monotherapy.
Conclusions: Antihyperglycemics with metformin did not reduce hyperglycemic-related emergency department incidence rates compared to metformin monotherapy. Depression was strongly associated with increased incidence and recurrence, while metformin with a sodium-glucose cotransporter 2 inhibitor was associated with lower all-cause mortality.
Recommended Citation
Naranjo, Fernando, "Impact of Antihyperglycemics on Emergency Department Visits for Hyperglycemia in Type 2 Diabetics" (2025). Yale School of Medicine Physician Associate Program Theses. 232.
https://elischolar.library.yale.edu/ysmpa_theses/232
Comments
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