Hospitalization Trends and Inpatient Mortality in Hyperosmolar Hyperglycemic State

This retrospective, interrupted-time study of the Nationwide Inpatient Sample (NIS) found that hospitalizations of people with type 2 diabetes (T2D) for hyperosmolar hyperglycemic state (HHS) increased while inpatient mortality, length of stay, and mean hospital cost decreased between 2008 and 2018 in the US. The study also found that most hospitalizations were among men, mean age was 57 to 59 years, the most common insurer was Medicaid, and HHS has become more common among whites and Hispanics. The reported mortality rates of 0.8% to 1.4% stand in stark contrast to historically reported rates of 5% to 20%,¹ representing a triumph of current approaches to evaluating and managing HHS. Another difference from historical data is the younger age of HHS patients, as HHS has been typically considered to be most common in much older adults. The increase in HHS incidence undoubtedly reflects the underlying increase in the prevalence of T2D during the study period. Correspondingly, there has also been an increase in the incidence of DKA over the past decade.² It would have been interesting to see an analysis of total hospital costs over time, given that mean hospital cost decreased while incidence increased. Notwithstanding, this is an important update to our understanding of HHS epidemiology in the US.  

References

1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-43. https://diabetesjournals.org/care/article/32/7/1335/27093/Hyperglycemic-Crises-in-Adult-Patients-With
2. Ramphul K, Joynauth J. An Update on the Incidence and Burden of Diabetic Ketoacidosis in the U.S. Diabetes Care. 2020;43(12):e196-e197. https://diabetesjournals.org/care/article/43/12/e196/31050/An-Update-on-the-Incidence-and-Burden-of-Diabetic