Cited by 53Diabetes Management and ResearchDialysis and Renal Disease ManagementChronic Kidney Disease and Diabetes

Hypoglycemic and hyperglycemic crises among u.S. Adults with diabetes and end-stage kidney disease: Population-based study, 2013-2017

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Galindo, Rodolfo J., Ali, Mohammed K., Funni, Shealeigh A., Dodge, Andrew B., Kurani, Shaheen S., Shah, Nilay D., Umpierrez, Guillermo E., McCoy, Rozalina G.·2022·Diabetes Care

Abstract

OBJECTIVE: We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabetes and end-stage kidney disease (ESKD). RESEARCH DESIGN AND METHODS: This was a nationwide, retrospective study of adults (≥18 years old) with diabetes/ESKD, from the United States Renal Data System registry, between 2013 and 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1,000 person-years. Event rates and risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality, comorbidities, treatment regimen, and U.S. region. RESULTS: Among 521,789 adults with diabetes/ESKD (median age 65 years [interquartile range 57–73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1,000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, respectively, the risks decreased with age and were lowest in older patients (≥75 vs. 18–44 years old: incidence rate ratio 0.35, 95% CI 0.33–0.37, and 0.03, 0.02–0.03), women (1.09, 1.06–1.12, and 1.44, 1.35–1.54), and those with smoking (1.36, 1.28–1.43, and 1.71, 1.53–1.91), substance abuse (1.27, 1.15–1.42, and 1.53, 1.23–1.9), retinopathy (1.10, 1.06–1.15, and 1.36, 1.26–1.47), and insulin therapy (vs. no therapy; 0.60, 0.59–0.63, and 0.44, 0.39–0.48). For hypoglycemia, specifically, additional risk was conferred by Black race (1.11, 1.08–1.15) and amputation history (1.20, 1.13–1.27). CONCLUSIONS: In this nationwide study of patients with diabetes/ESKD, hypoglycemic crises were threefold more common than hyperglycemic crises, greatly exceeding national reports in nondialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected.

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  • Hypoglycemia from severe systemic illness (spontaneous hypoglycemia), not insulin-induced hypoglycemia, is linked to higher inpatient mortality and complications.

    “Hypoglycemia resulting from severe systemic illness (spontaneous hypoglycemia), rather than insulin-induced hypoglycemia, is associated with increased risk of inpatient mortality and complications.1366–1368”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1366]

    The Study Outcomes section tracks emergency visits and hospitalizations for glycemic crises, and the Conclusions discuss their frequency and risk factors in adults with diabetes and end-stage kidney disease. Searches for spontaneous hypoglycemia, severe systemic illness, and inpatient mortality found no passage comparing illness-related with insulin-induced hypoglycemia or reporting their relative inpatient outcomes. (LLM, conf=0.76)

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Authors
Galindo, R. J., Ali, M. K., Funni, S. A., Dodge, A. B., Kurani, S. S., Shah, N. D., Umpierrez, G. E., & McCoy, R. G.
Affiliations
  • Emory University (US)
  • Mayo Clinic (US)
Corresponding author
Galindo, Rodolfo J.
Venue
Diabetes Care
Published
2021-11-05
Volume
45
Issue
1
Pages
100-107
ISSN
0149-5992 (ISSN-L)
OpenAlex
W3210806742
Cited by
53
References
27
Citations by year
2026: 12 · 2025: 15 · 2024: 16 · 2023: 6 · 2022: 4
FWCI
4.85
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1TR002378)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497, R03DK127010, K23DK123384, P30DK111024)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
hypoglycemic crisis, hyperglycemic crisis, diabetic ketoacidosis, hyperosmolar hyperglycemic state, diabetes mellitus, end-stage renal disease, dialysis, emergency department visits, hospitalization, incidence trends, risk factors, insulin therapy, smoking, substance abuse, retinopathy, older adults, sex differences, racial and ethnic disparities, health disparities, United States
MeSH terms
Adolescent, Adult, Aged, Diabetes Mellitus, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Kidney Failure, Chronic, Male, Retrospective Studies, United States, Diabetic Ketoacidosis, Young Adult

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