IDF21-0157 Trends in Severe Hypoglycemia, Hyperglycemia, and Diabetic Ketoacidosis among American Indian and Alaska Native Peoples

Abstract

Background: American Indian and Alaska Native peoples (AI/ANs) suffer daunting disparities in diabetes and its complications. Little is known about rates of and changes in acute diabetes complications among AI/ANs. Aim: Here we investigate the time trends of hospital admissions and emergency department (ED) visits for hypoglycemia, hyperglycemia, and diabetic ketoacidosis (DKA) from 2009 to 2013 among AI/AN diabetes patients. Method: Data were extracted from the Indian Health Service’s (IHS) National Data Warehouse and related electronic health record databases. A total of 48,871 AI/AN adults with diabetes who used IHS services during any of the fiscal years 2009-2013 were included. Observed rates of hospitalizations or ED visits due to each complication were calculated for each year. Generalized estimating equation models with a binomial distribution and logit link were fitted to examine the time trend of each complication. Results: The proportions of AI/AN diabetes patients with severe hypoglycemia (1.35% in 2009 vs. 0.70% in 2013), hyperglycemia (1.72% vs. 1.44%), and DKA (0.54% vs. 0.43%) that led to hospitalizations or ED visits all declined gradually. Male patients and those with Medicaid enrollment had substantially higher rates of these complications across five years, while patients with private insurance had significantly lower rates of them. Discussion: AI/AN adults with diabetes had significant improvements in both hypoglycemic and hyperglycemic crises from 2009-2013. Our findings further support the effectiveness of the systematic diabetes management approach implemented by the IHS in the past few decades.