Study Details Rates of Glycemic Emergencies Among Medicare Beneficiaries from 2011-2020

An analysis of data from Medicare Advantage beneficiaries with type 1 or type 2 diabetes is providing an overview of trends in incidence of glycemic emergencies in the US from 2011-2020.

Results of the study, which included more than 2.5 million adults with diabetes, results indicate rates of incidence for both severe hypoglycemia and hyperglycemia among people with type 1 diabetes had increased during the study period, while rates of severe hypoglycemia decreased among those with type 2 diabetes.

“Our findings underscore the importance of preventing severe hypoglycemia and hyperglycemia, closely monitoring patients who experience them, and intervening to prevent recurrence,” wrote investigators.

Since the landmark Diabetes Control and Complications trial indicated optimal glycemic control was associated with a reduction in adverse outcomes, the diabetes community has experienced a revolution in therapy and management. The current research endeavor was launched by a team of collaborators from the Mayo Clinic and Yale School of Medicine with an interest in exploring trends in hospitalizations for glycemic emergencies in the US. With this in mind, investigators designed their study as an analysis of claims data from Medicare Advantage beneficiaries with type 1 or type 2 diabetes using OptumLabs Data Warehouse, with a period of interest defined as January 1, 2011-December 31, 2020.

The primary endpoints of interest for the analyses were rate of hypoglycemia- and hyperglycemia-related emergency department visits or hospitalizations among those with type 1 and type 2 diabetes, which was expressed as number of events per 1000 person-years and adjusted for patient age, sex, race, ethnicity, and region.

Investigators identified a total of 67,901 adults with type 1 diabetes and 2,483,951 adults with type 2 diabetes for inclusion in their analyses. The cohort of people with type 1 diabetes had a mean age of 43.2 (SD, 16.1) years, 52.8% were male, and 71.8% were non-Hispanic White. The cohort of people with type 2 diabetes had a mean age of 62.6 (SD, 12.5) years, 50.5% were males, and 56.3% were non-Hispanic White.

Among those with type 1 diabetes, adjusted rates of severe hypoglycemia increased from 25.7 per 1000 person-years in 2011 to 32.9 per 1000 person-years in 2019 and then decreased to 25.6 per 1000 person-years in 2020 (P=.87). The adjusted rates of severe hyperglycemia increased from 30.0 per 1000 person-years in 2011 to 47.2 per 1000 person-years in 2019 and then decreased to 44.5 per 1000 person-years in 2020 (P=.006).

Among those with type 2 diabetes, adjusted rates of severe hypoglycemia decreased from 9.6 per 1000 person-years in 2011 to 8.6 per 1000 person-years in 2019 and then declined further to 7.0 per 1000 person-years in 2020 (P=.02). The adjusted rates of severe hyperglycemia increased from 2.6 per 1000 person-years in 2011 to 3.3 per 1000 person-years in 2019 and remained consistent at 3.2 per 1000 person-years in 2020 (P=.03).

“Further research is needed to probe for the reasons for the observed deterioration of glycemic management among people with type 1 diabetes, with higher rates of both severe hypoglycemia and hyperglycemia, and why people with type 2 diabetes who saw improvements in the rates of severe hypoglycemia did not see similar declines in severe hyperglycemia,” investigators concluded.

This study, “Rates of Hypoglycemic and Hyperglycemic Emergencies Among U.S. Adults With Diabetes, 2011–2020,” was published in Diabetes Care.