Outpatient Follow-up Care for Diabetes Following Discharge From the Emergency Department

Diabetes-related conditions account for over 16 million emergency department (ED) visits annually. Though most patients are discharged from the ED, outpatient follow-up is essential for medication adjustment, symptom monitoring, and counseling. National patterns of diabetes outpatient follow-up after ED discharge remain poorly characterized.

We conducted a retrospective cohort study using administrative claims data from the Optum Clinformatics® Data Mart, which includes commercially insured and Medicare Advantage beneficiaries in the United States. The study period spanned July 2016-May 2022. We identified ED encounters with a principal diagnosis of type 1 or type 2 diabetes mellitus using ICD-10-CM codes. We excluded patients who were hospitalized, expired in the ED, or had been hospitalized in the preceding 30 days. The primary outcome was an outpatient visit for diabetes-related care within 30 days of ED discharge, identified using Common Procedural Terminology (CPT) codes. Return ED visits before follow-up were treated as a competing outcome. We used competing risk regression models to estimate adjusted hazard ratios (aHRs) for patient characteristics associated with obtaining follow-up care.

The study included 131,881 patients discharged from the ED for diabetes-related encounters (mean age, 63.0 years; 51.6% female). Within 30 days of discharge, 60,798 (46.1%) patients obtained outpatient follow-up care, while 17,099 (13.0%) returned to the ED before follow-up. Follow-up rates increased over time, from 44% in 2016 to 49% in 2022. In adjusted analyses, older age (aHR 1.11, 95% CI 1.08-1.14), commercial insurance (aHR 1.11, 95% CI 1.08-1.14), and greater prior outpatient engagement (aHR 1.32, 95% CI 1.29-1.36) were associated with higher likelihood of follow-up. Patients with non-Hispanic Black race (aHR 0.97, 95% CI 0.95-0.99), Medicare low-income subsidy (aHR 0.95, 95% CI 0.93-0.97), greater comorbidity burden (aHR 0.99, 95% CI 0.99-0.99), and type 1 diabetes (aHR 0.69, 95% CI 0.66-0.71) had lower likelihood of follow-up.

In this national cohort of adults discharged from the ED for diabetes encounters, fewer than half obtained outpatient follow-up care within 30 days. A substantial proportion returned to the ED before receiving follow-up. These findings demonstrate significant gaps in diabetes care continuity following ED discharge.