Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state: A 14-year time-series analysis

Chin Li Lu, Hsin Hui Chang, Hua Fen Chen, Li-Jung Elizabeth Ku, Ya Hui Chang, Hsiu Nien Shen, Chung-Yi Li

Research output: Contribution to journalArticle

Abstract

This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Monthly temperature averaged from 19 meteorological stations across Taiwan was correlated with monthly rate of admission for DKA or HHS, respectively, using the ‘seasonal Autoregressive Integrated Moving Average’ (seasonal ARIMA) regression method. There was an inverse relationship between ambient temperature and rates of admission for DKA (β = − 0.035, p < 0.001) and HHS (β = − 0.016, p < 0.001), despite a clear decline in rates of DKA/HHS admission in the second half of the study period. We also noted that winter was significantly associated with increased rates of both DKA (β = 0.364, p < 0.001) and HHS (β = 0.129, p < 0.05) admissions, as compared with summer. On the other hand, fall was associated with a significantly lower rate of HHS admission (β = − 0.016, p < 0.05). Further stratified analyses according to sex and age yield essentially similar results. It is suggested that meteorological data can be used to raise the awareness of acute hyperglycemic complication risk for both patients with diabetes and clinicians to further avoid the occurrence of DKA and HHS.

Original languageEnglish
Pages (from-to)642-648
Number of pages7
JournalEnvironment International
Volume94
DOIs
Publication statusPublished - 2016 Sep 1

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time series analysis
diabetes
morbidity
temperature
rate
time series
winter
summer

All Science Journal Classification (ASJC) codes

  • Environmental Science(all)

Cite this

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title = "Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state: A 14-year time-series analysis",
abstract = "This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Monthly temperature averaged from 19 meteorological stations across Taiwan was correlated with monthly rate of admission for DKA or HHS, respectively, using the ‘seasonal Autoregressive Integrated Moving Average’ (seasonal ARIMA) regression method. There was an inverse relationship between ambient temperature and rates of admission for DKA (β = − 0.035, p < 0.001) and HHS (β = − 0.016, p < 0.001), despite a clear decline in rates of DKA/HHS admission in the second half of the study period. We also noted that winter was significantly associated with increased rates of both DKA (β = 0.364, p < 0.001) and HHS (β = 0.129, p < 0.05) admissions, as compared with summer. On the other hand, fall was associated with a significantly lower rate of HHS admission (β = − 0.016, p < 0.05). Further stratified analyses according to sex and age yield essentially similar results. It is suggested that meteorological data can be used to raise the awareness of acute hyperglycemic complication risk for both patients with diabetes and clinicians to further avoid the occurrence of DKA and HHS.",
author = "Lu, {Chin Li} and Chang, {Hsin Hui} and Chen, {Hua Fen} and Ku, {Li-Jung Elizabeth} and Chang, {Ya Hui} and Shen, {Hsiu Nien} and Chung-Yi Li",
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Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state : A 14-year time-series analysis. / Lu, Chin Li; Chang, Hsin Hui; Chen, Hua Fen; Ku, Li-Jung Elizabeth; Chang, Ya Hui; Shen, Hsiu Nien; Li, Chung-Yi.

In: Environment International, Vol. 94, 01.09.2016, p. 642-648.

Research output: Contribution to journalArticle

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AU - Li, Chung-Yi

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