Trends in Emergency Department Visits and Inpatient Admissions for Hyperglycemic Crises in Adults With Diabetes in the U.S., 2006-2015

Abstract

Objective: To report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient settings.

Research design and methods: We analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults ≥18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software.

Results: In 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18-44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45-64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age-groups and in both men and women.

Conclusions: Causes of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies.

Figure 1

Age-adjusted DKA ED and hospitalization rates per 1,000 adults with diagnosed diabetes, 2009–2015. Numerator data are from the NEDS and NIS. Denominator data are from National Center for Health Statistics’ NHIS. Dots are observed annual values. The lines are modeled using Joinpoint Trend Analysis Software. The 2000 U.S. Census was used for age-adjustment using age-groups 18–44, 45–64, and ≥65 years.

Figure 2

Age-adjusted HHS ED and hospitalization rates per 10,000 adults with diagnosed diabetes, 2009–2015. Numerator data are from the NEDS and NIS. Denominator data are from National Center for Health Statistics’ NHIS. Dots are observed annual values. The lines are modeled using Joinpoint Trend Analysis Software. The 2000 U.S. Census was used for age-adjustment using age-groups 18–44, 45–64, and ≥65 years.