Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA

Pediatr Diabetes. 2013 Feb;14(1):18-24. doi: 10.1111/j.1399-5448.2012.00897.x. Epub 2012 Aug 28.


Background: Previous studies of hyperglycemic hyperosmolar syndrome (HHS) in children are limited to case series or single-institution reviews, which describe HHS primarily in children with type 2 diabetes mellitus.

Objective: To estimate the incidence and describe the epidemiologic characteristics of HHS among children in USA.

Subjects: All discharges in the Kids' Inpatient Database - a triennial, nationwide, stratified probability sample of hospital discharges for years 1997-2009 - with age 0-18 yr and a diagnosis of HHS.

Methods: Using sample weights, we calculated the incidence and population rate of hospitalization with a diagnosis of HHS.

Results: Our sample included 1074 HHS hospitalizations; of these, 42.9% were 16-18 yr, 70.6% had type 1 diabetes (T1D), and 53.0% had major or extreme severity of illness. The median length of stay was 2.6 d, 2.7% of hospitalizations ended in death, and median hospital charge was $10 882. When comparing HHS hospitalizations by diabetes type, the proportion with T1D fell steadily with age, from 89.1% among children 0-9 yr, to 65.1% in 16-18 yr olds. Patients with T1D had a shorter length of stay by 0.9 d, and had a lower median charge by $5311. There was no difference in mortality by diabetes type. Population rates for HHS hospitalization rose 52.4% from 2.1 to 3.2 per 1 000 000 children from 1997 to 2009.

Conclusion: Hospitalizations for a diagnosis of HHS have high morbidity and are increasing in incidence since 1997. In contrast to prior reports, we found a substantial percentage of HHS hospitalizations occurred among children with T1D.

MeSH terms

  • Adolescent
  • Child
  • Child Mortality
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / therapy
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hyperglycemic Hyperosmolar Nonketotic Coma / diagnosis
  • Hyperglycemic Hyperosmolar Nonketotic Coma / epidemiology*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / mortality
  • Hyperglycemic Hyperosmolar Nonketotic Coma / therapy
  • Infant
  • Infant, Newborn
  • Male
  • Syndrome
  • United States / epidemiology