Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006–2015

Benoit, Stephen R.; Hora, Israel; Pasquel, Francisco J.; Gregg, Edward W.; Albright, Ann L.; Imperatore, Giuseppina

doi:10.2337/dc19-2449

Cited by 117Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006–2015

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Benoit, Stephen R., Hora, Israel, Pasquel, Francisco J., Gregg, Edward W., Albright, Ann L., Imperatore, Giuseppina·2020·Diabetes Care

DOI 10.2337/dc19-2449PMC PMC7171947

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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.

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Hospitalization rates for diabetic ketoacidosis are increasing.
“Since hospitalization rates for DKA are increasing (310), further studies are needed to determine more optimal home testing strategies to detect impending ketonemia.”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [310]
In the U.S., national surveillance of emergency department visits and hospital admissions suggests a rate of 28 cases per 1,000 adults with diabetes per year, with a worrisome increase in emergency department visits and admissions for DKA seen since 2009.
“In the U.S., national surveillance of emergency department visits and hospital admissions suggests a rate of 28 cases per 1,000 adults with diabetes per year, with a worrisome increase in emergency department visits and admissions for DKA seen since 2009 (209).”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [209]

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Authors: Benoit, S. R., Hora, I., Pasquel, F. J., Gregg, E. W., Albright, A. L., & Imperatore, G.
Affiliations: Centers for Disease Control and Prevention (US)
Emory University (US)
Corresponding author: Benoit, Stephen R.
ORCID: Benoit, Stephen R.
Pasquel, Francisco J.
Gregg, Edward W.
Imperatore, Giuseppina
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2020-03-11
Volume: 43
Issue: 5
Pages: 1057-1064
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc19-2449
PMC: PMC7171947
OpenAlex: W3011649631
Semantic Scholar: e24b38fdc6603bcdb4c3c516764c774188c1aae0
Cited by: 117
References: 33
Citations by year: 2026: 12 · 2025: 20 · 2024: 19 · 2023: 19 · 2022: 19 · 2021: 17 · 2020: 11
FWCI: 12.44
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.diabetesjournals.org/content/license (vor, 40 d)
Locations: Diabetes Care (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of General Medical Sciences (K23GM128221)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: diabetic ketoacidosis, hyperosmolar hyperglycemic state, diabetes mellitus, emergency department visits, hospitalization, trends, type 1 diabetes, type 2 diabetes, young adults, low-income populations
MeSH terms: Adolescent, Adult, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Emergency Service, Hospital, Female, Humans, Hyperglycemic Hyperosmolar Nonketotic Coma, Inpatients, Male, Middle Aged, Patient Admission, United States, Diabetic Ketoacidosis, History, 20th Century, History, 21st Century, Young Adult

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Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006–2015

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