National Trends in US Hospital Admissions for Hyperglycemia and Hypoglycemia Among Medicare Beneficiaries, 1999 to 2011

Abstract

The increasing intensity of diabetes mellitus management over the past decade may have resulted in lower rates of hyperglycemic emergencies but higher rates of hospital admissions for hypoglycemia among older adults. Trends in these hospitalizations and subsequent outcomes are not known.OBJECTIVE To characterize changes in hyperglycemia and hypoglycemia hospitalization rates and subsequent mortality and readmission rates among older adults in the United States over a 12-year period, and to compare these results according to age, sex, and race. DESIGN, SETTING, AND PATIENTS Retrospective observational study using data from 33 952 331 Medicare fee-for-service beneficiaries 65 years or older from 1999 to 2011. MAIN OUTCOMES AND MEASURESHospitalization rates for hyperglycemia and hypoglycemia, 30-day and 1-year mortality rates, and 30-day readmission rates.RESULTS A total of 279 937 patients experienced 302 095 hospitalizations for hyperglycemia, and 404 467 patients experienced 429 850 hospitalizations for hypoglycemia between 1999 and 2011. During this time, rates of admissions for hyperglycemia declined by 38.6% (from 114 to 70 admissions per 100 000 person-years), while admissions for hypoglycemia increased by 11.7% (from 94 to 105 admissions per 100 000 person-years). In analyses designed to account for changing diabetes mellitus prevalence, admissions for hyperglycemia and hypoglycemia declined by 55.2% and 9.5%, respectively. Trends were similar across age, sex, and racial subgroups, but hypoglycemia rates were 2-fold higher for older patients (Ն75 years) when compared with younger patients (65-74 years), and admission rates for both hyperglycemia and hypoglycemia were 4-fold higher for black patients compared with white patients. The 30-day and 1-year mortality and 30-day readmission rates improved during the study period and were similar after an index hospitalization for either hyperglycemia or hypoglycemia (5.4%, 17.1%, and 15.3%, respectively, after hyperglycemia hospitalizations in 2010; 4.4%, 19.9%, and 16.3% after hypoglycemia hospitalizations).CONCLUSIONS AND RELEVANCE Hospital admission rates for hypoglycemia now exceed those for hyperglycemia among older adults. Although admissions for hypoglycemia have declined modestly since 2007, rates among black Medicare beneficiaries and those older than 75 years remain high. Hospital admissions for severe hypoglycemia seem to pose a greater health threat than those for hyperglycemia, suggesting new opportunities for improvement in care of persons with diabetes mellitus.

Trends in hospital admissions for hypoglycaemia in England: a retrospective, observational study

“…Lipska et al, 17 relying upon health insurance data to collect information on admissions for hypoglycaemia and national surveys to calculate diabetes prevalence, estimated trends of hospital admissions for hypoglycaemia in people aged 65 years or older at national level. From 1999 to 2011, they reported an absolute increase until 2007 and a subsequent decline, with a significant 11% increase of sex-, age-, and ethnicity-adjusted rate comparing 2011 to 1999.…”

“…First, in those investigating temporal trends, absolute admissions reach a peak (2007 in US; 17 Hypoglycaemia has gathered great attention in recent years, particularly after the publication of randomised controlled trials showing a nonsignificant reduction or even an increase in vascular risk in intensively treated subjects. 30 Glycaemic control targets may therefore have relaxed during the study period at the expense of higher rates of hyperglycaemia, as suggested in some but not all previous studies.…”

Hypoglycemia Risk Factors among Hospitalized Type 2 Diabetes Mellitus Patients

“…16453 burden than inpatients with hyperglycemic. 5 Previous study showed that several risk factors of hypoglycemic events included elderly, increased physical activity, decreased carbohydrate intake, alcohol consumption, strict glycemic control, impaired renal or liver function, infection, presence of comorbidities, changes in pharmacological therapy regimens, and polypharmacy. [6][7][8][9] Glycemic control should be done individually based on patient characteristics.…”

Technology to Reduce Hypoglycemia

“…9 In the US, rates of admissions for hypoglycemia have increased in recent years to 105 admissions per 100 000 person-years. 10 Antecedent hypoglycemia has been shown to blunt symptom and counter-regulatory hormonal responses to subsequent hypoglycemia.11 Over time, recurrent hypoglycemia eventually leads to a reduction in the ability to detect hypoglycemia and mount a hormonal response to it, known as impaired awareness of hypoglycemia (IAH) which can increase the risk of SH 6-fold. 12 In the T1D Exchange clinic registry, ≥ 1 SH events occurred in ~6% of over 9000 participants within 12 months, and was not associated with baseline glycated hemoglobin (HbA1c) levels.…”

“…9 In the US, rates of admissions for hypoglycemia have increased in recent years to 105 admissions per 100 000 person-years. 10 Antecedent hypoglycemia has been shown to blunt symptom and counter-regulatory hormonal responses to subsequent hypoglycemia.…”