Trends and Disparities in Rates of Hypoglycemia Among Hospitalized Patients with Type II Diabetes

Objective: Hypoglycemia is a common complication of inpatient care for patients with diabetes. We sought to determine recent trends and demographic disparities in the rate of inpatient hypoglycemia.

Research Design and Methods: We used data from the Veterans Affairs (VA) health care system to identify all patients with type 2 diabetes hospitalized from 2016-2022. We determined rates of inpatient hypoglycemia (< 70 mg/dl) and discharge diagnosis coding for hypoglycemia. We determined differences in rates of hypoglycemia by age, gender and race/ethnicity, adjusting for other patient diagnoses, laboratory values, vital signs and insulin use.

Results: Among 512,261 patients hospitalized with diabetes, 6.8% (34,918) had an episode of hypoglycemia (< 70 mg/dl). This rate decreased by 17% from 2016-2022 (7.4% to 6.3%) while the rate of discharge diagnosis among those with hypoglycemia increased. After adjustment for other patient characteristics, the youngest and oldest patients, and those hospitalized in earlier years (vs. 2022) had significantly higher rates of hypoglycemia. Black (adjusted odds ratio -aOR, 1.42 95% CI 1.36-1.49) or Hispanic patients (aOR 1.26 95% CI 1.17-1.35) had a greater risk of hypoglycemia compared with non-Hispanic White patients and women had borderline less hypoglycemia than men (aOR 0.95, 95% CI 0.89-1.00)

Conclusion: Inpatient hypoglycemia in the VA Health System has been declining though there are race, age and gender differences that remain unexplained. Recognition of hypoglycemia, defined as a discharge diagnosis, is increasing.