American Diabetes Association
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Trends and inequalities in diabetes-related complications among US adults, 2000-2020

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posted on 2024-06-21, 00:10 authored by Ryan Saelee, Kai McKeever Bullard, Israel A. Hora, Meda E. Pavkov, Francisco J. Pasquel, Christopher S. Holliday, Stephen R. Benoit

Objective: We examined national trends in diabetes-related complications (heart failure [HF] myocardial infarction [MI], stroke, end-stage renal disease [ESRD], nontraumatic lower extremity amputations [NLEA], and hyperglycemic crisis) among US adults with diagnosed diabetes during 2000–2020 by age group, race and ethnicity, and sex. We also assessed trends in inequalities among those subgroups. Research Design and Methods: Hospitalization rates for diabetes-related complications among adults (≥18 years) were estimated using the 2000-2020 National Inpatient Sample. The incidence of diabetes-related ESRD was estimated using the United States Renal Data System. The number of US adults with diagnosed diabetes was estimated from the National Health Interview Survey. Annual percent change (APC) was estimated to assess trends. Results: After declines in the early 2000s, hospitalization rates increased for HF (2012-2020, APC: 3.9%, p<0.001), stroke (2009-2020, APC: 2.8%, p<0.001), and NLEA (2009-2020, APC: 5.9%, p<0.001) while ESRD incidence increased (2010-2020, APC:1.0%, p=0.044). Hyperglycemic crisis increased from 2000-2020 (APC: 2.2% p<0.001). MI hospitalizations declined during 2000-2008 (APC: -6.0%, p<0.001) and were flat thereafter. On average, age inequalities declined for hospitalizations for heart failure, MI, stroke, and ESRD incidence but increased for hyperglycemic crisis. Sex inequalities increased on average for hospitalizations for stroke and NLEA, and for ESRD incidence. Racial and ethnic inequalities declined during 2012-2020 for ESRD incidence but increased for HF, stroke, and hyperglycemic crisis. Conclusions: There was a continued increase of several complications in the past decade. Age, sex, and racial and ethnic inequalities have worsened for some complications.


The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.