Mortality among People with Diabetes Experiencing Hypoglycemic and Hyperglycemic Crises

Severe hypoglycemia and hyperglycemia (ketoacidosis, hyperglycemic hyperosmolar state) are common yet potentially preventable acute complications of diabetes. Our objectives were to use national data from OptumLabs® Data Warehouse, 2011-2020, to 1) characterize trends in all-cause mortality among adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) experiencing emergency department visits or hospitalizations for hypoglycemia and hyperglycemia;2) extend analyses through 2020 to assess the impact of the COVID-pandemic;and 3) examine racial/ethnic and gender disparities in subsequent mortality adjusted for relevant patient characteristics. Among 4,164 adults with T1DM experiencing hypoglycemia, 30-day and 1-year mortality increased from 0.5% to 0.9% and 4.7% to 6.1%. Among 49,931 adults with T2DM experiencing hypoglycemia, 30-day and 1-year mortality were stable at 2.1-2.0% and 16.2-16.1%. Among 4,698 adults with T1DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 0.4% to 1.0% and 2.7% to 5.9%, respectively. Among 17,123 adults with T2DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 2.5% to 3.0% and 11.5% to 13.1%. Table shows differences in mortality rates by age, race/ethnicity, gender. These results call for proactive engagement of high risk individuals experiencing severe hypoglycemia and hyperglycemia to reduce their risk of death.