National Trends and Predictors of Adverse Outcomes in Hypoglycemia Hospitalizations in the United States, 2017–2022
Abu Huraira Bin Gulzar, Sheraz Hakeem, Muhammad Umer Sohail, Aima Tahir, Tamseer Tariq, Rasheeda Shehroz, Moiz Shah Khan, Ismail Rahim, Umme Aiman, Muhammad Afnan Ashraf, Shanzey Rai, Marriam Mavora, Asad Ali Ahmed Cheema, Hina NadeemABSTRACT
Objective
To assess national trends and inpatient outcomes among adults hospitalized with a primary diagnosis of hypoglycemia in the United States from 2017 to 2022.
Methods
We conducted a retrospective cross‐sectional analysis of the National Inpatient Sample. Adult hospitalizations aged 18 years or older with a principal ICD‐10‐CM diagnosis of hypoglycemia were included. The annual share of primary hypoglycemia hospitalizations was calculated per 100,000 adult NIS discharges. Outcomes included in‐hospital mortality, length of stay(LOS), and inflation‐adjusted hospital cost standardized to 2022 US dollars. Multivariable survey‐weighted logistic regression was used for mortality, a survey‐weighted generalized linear model (GLM) with a quasi‐Poisson distribution and log link was used for LOS, and a survey‐weighted GLM with a gamma distribution and log link was used for inflation‐adjusted hospital cost.
Results
The analysis included 330,910 weighted hypoglycemia hospitalizations. Mean age was 67 years; 52% were women; and 70% were Medicare‐insured. Diabetes mellitus (91%) was the most common comorbidity, while obesity (17%) was least common. Primary‐hypoglycemia discharges peaked in 2019 (195 per 100,000 adult NIS discharges), declined in 2021 (180), and increased again in 2022 (190). Mortality occurred in 1.6%, and median LOS was 3 days. Compared with 2017, adjusted mortality odds were higher in 2020 (OR 1.30, 95% CI 1.04–1.61), 2021 (OR 1.44, 95% CI 1.16–1.79), and 2022 (OR 1.33, 95% CI 1.07–1.65). Similarly, LOS and hospital costs were also higher in 2020, 2021, and 2022 compared to 2017. Congestive heart failure (CHF) and AF were associated with higher mortality odds, LOS, and cost.
Conclusion
Primary hypoglycemia hospitalizations declined during the pandemic years but became more severe and resource‐intensive over time. Patients with CHF or AF had higher mortality, higher LOS, and higher hospital costs, highlighting the need for integrated hypoglycemia surveillance and cardiometabolic care.