Severe hypoglycemia and hyperglycemia in diabetes management are dangerous yet potentially preventable. Data on contemporary trends of these events, mortality following their occurrence, and potential racial/ethnic disparities are limited. We used claims data from OptumLabs Data Warehouse to 1) examine rates of hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes between 2009 and 2018; 2) quantify 30-day and 1-year all-cause mortality after these events adjusted for age, sex, race/ethnicity, and U.S. region; and 3) assess for disparities by race/ethnicity.

Among 3,709,936 adults with diabetes (age 60.2 [SD, 13.7] years, 49.2% female, 58.5% White), the adjusted rate of hypoglycemic emergencies per 1000 person-years decreased by 41% from 2009 to 2018, from 16.2 (95% CI, 15.8-16.6) to 9.6 (9.4-9.8). The adjusted rate of hyperglycemic emergencies increased by 24%, from 4.6 (4.5-4.8) to 5.7 (5.6-5.9). Black patients had the highest risk of both events compared to Whites, with RR 1.7 (1.7-1.8) for hypoglycemic and 1.5 (1.4-1.5) for hyperglycemic emergencies. All-cause 30-day and 1-year mortality did not change over time. In 2018, 30-day adjusted mortality was 1.6% (1.4-1.8) and 1.3% (1.1-1.5) after hypoglycemic and hyperglycemic emergencies, respectively, while 1-year mortality was 10.3% (9.8-10.9) and 4.7% (4.2-5.2). The risks of 30-day and 1-year mortality after hypoglycemic emergencies were lower among Black (OR 0.85 [0.76-0.96] and OR 0.91 [0.87-0.96], respectively) and Hispanic (OR 0.81 [0.68-0.97] and OR 0.70 [0.64-0.76]) patients compared to Whites. There was no association between race/ethnicity and 30-day mortality after hyperglycemic emergencies, while the risk of 1-year mortality was lower among Hispanic patients (OR 0.73 [0.63, 0.85]) compared to Whites.

New strategies are needed to prevent hypoglycemic and hyperglycemic emergencies among people with diabetes, particularly among racial/ethnic minorities.

Disclosure

R. G. Mccoy: None. K. Swarna: None. R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. H. Van houten: None. P. J. O’connor: None. N. Shah: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

© 2021 by the American Diabetes Association
2021
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