Hospitalization and Emergency Department Visits for Severe Hypoglycemia among U.S. Adults with Diabetes and Serious Comorbid Conditions

Abstract

Diabetes care guidelines recommend more relaxed glycemic targets for patients with specific chronic conditions because they are thought to have an increased risk of hypoglycemia, limited life expectancy, and/or high clinical complexity. These include dementia, end stage renal disease (ESRD), stages 3-4 chronic kidney disease (CKD), myocardial infarction, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, arthritis, urinary incontinence, falls, depression, hypertension, cirrhosis, proliferative retinopathy, and peripheral neuropathy. The rates of severe hypoglycemia among patients with these conditions are unknown. We quantified rates of hospital and emergency department care for hypoglycemia among 216,839 adults (mean 65.5 years old) with diabetes in 2015 using the OptumLabs Data Warehouse (administrative database of >100 million commercially-insured and Medicare Advantage beneficiaries). Hypoglycemia rates varied widely: 10.6/1000 person-years (PY) in patients with hypertension, 26.9/1000 PY with CKD, 26.8/1000 PY with cirrhosis, 37.7/1000 PY with dementia, and 58.3/1000 PY with ESRD. Hypoglycemia was rare among patients with no conditions (2.0/1000 PY). After adjustment for all conditions, prior hypoglycemia, age, sex, race, HbA1c, and diabetes medications, the risk of severe hypoglycemia was significantly increased for all conditions except arthritis, incontinence, and cancer. Hypoglycemia risk increased rapidly with the number of comorbidities: OR 1.8 (95% CI 1.4, 2.2) for 2 conditions, 7.7 (6.2, 9.64) for 5, 16.6 (13.1, 21.1) for 7, and 25.6 (30.4, 32.2) for ?8 conditions compared with ?1 condition. Severe hypoglycemia is common among patients with chronic conditions. Rates vary between conditions but increase dramatically in patients with multiple comorbidities. These data can help inform decisions about glucose-lowering therapy for patients with comorbidities. Disclosure R.G. McCoy: None. H. Van Houten: None. K.J. Lipska: Other Relationship; Self; Centers for Medicare and Medicaid Services. Research Support; Self; National Institutes of Health. N. Shah: None.