TY - JOUR
T1 - Hypoglycemic and Hyperglycemic Crises Among U.S. Adults With Diabetes and End-stage Kidney Disease
T2 - Population-Based Study, 2013–2017
AU - Galindo, Rodolfo J.
AU - Ali, Mohammed K.
AU - Funni, Shealeigh A.
AU - Dodge, Andrew B.
AU - Kurani, Shaheen S.
AU - Shah, Nilay D.
AU - Umpierrez, Guillermo E.
AU - McCoy, Rozalina G.
N1 - Funding Information:
Funding. This work was supported by the NIDDK of the National Institutes of Health (NIH) under award numbers P30DK111024 (to R.J.G.), K23DK123384 (R.J.G.), and K23DK114497 (R.G.M.). G.E.U. is partly supported by NIH/National Center for Advancing Translational Sciences (NATS)
Funding Information:
UL1 TR002378 from the Clinical and Translational Science Award program, and both M.K.A. and G.E.U. are partially supported by 1P30DK111024-01 from the NIH/NIDDK. R.G.M. is also supported by NIDDK (R03DK127010). The funders had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. The database for analyses was provided by the USRDS under a standard data use agreement. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the U.S. Government. Duality of Interest. R.J.G. received research support to Emory University for investigator-initiated studies from Novo Nordisk, Dexcom, and Eli Lilly and consulting fees from Abbott Diabetes Care, Sanofi, Valeritas, Eli Lilly, Novo Nordisk, and Weight Watchers outside of this work. G.E.U. has also received unrestricted research support for research studies (to Emory University) from Merck, Novo Nordisk, Dexcom, and Sanofi. No other potential conflicts of interest relevant to this article were reported. Authors Contributions. R.J.G. and R.G.M. developed the study’s concept and initial protocol, had full access to all the data analyses, and take responsibility for the accuracy of the results. All authors contributed to the study concept and design. R.J.G., S.A.F., and R.G.M. contributed to acquisition and analysis of data. All authors contributed to interpretation of data. R.J.G. drafted the initial manuscript. All authors critically revised the manuscript for relevant intellectual content. S.A.F., A.B.D., and S.S.K. performed statistical analyses. R.J.G. and R.G.M. obtained funding. R.J.G. and R.G.M. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the 80th Scientific Sessions of the American Diabetes Association, 12–16 June 2020.
Publisher Copyright:
© 2021 by the American Diabetes Association.
PY - 2022/1
Y1 - 2022/1
N2 - OBJECTIVE We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabe¬tes and end-stage kidney disease (ESKD). RESEARCH DESIGN AND METHODS This was a nationwide, retrospective study of adults (S18 years old) with diabetes/ ESKD, from the United States Renal Data System registry, between 2013 and 2017. Pri¬mary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1,000 per¬son-years. Event rates and risk factors were adjusted for patient age, sex, race/ethnic¬ity, dialysis modality, comorbidities, treatment regimen, and U.S. region. RESULTS Among 521,789 adults with diabetes/ESKD (median age 65 years [interquartile range 73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1,000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, respectively, the risks decreased with age and were lowest in older patients (S75 vs. 18-44 years old: Incidence rate ratio 0.35, 95% CI 0.33-0.37, and 0.03, 0.02-0.03), women (1.09, 1.06-1.12, and 1.44, 1.35-1.54), and those with smoking (1.36, 1.28-1.43, and 1.71, 1.53-1.91), substance abuse (1.27, 1.15-1.42, and 1.53, 1.23-1.9), retinopathy (1.10, 1.06-1.15, and 1.36, 1.26-1.47), and insulin therapy (vs. no therapy; 0.60, 0.59-0.63, and 0.44, 0.39-0.48). For hypoglycemia, specifically, additional risk was conferred by Black race (1.11, 1.08-1.15) and amputation history (1.20, 1.13-1.27). CONCLUSIONS In this nationwide study of patients with diabetes/ESKD, hypoglycemic crises were threefold more common than hyperglycemic crises, greatly exceeding national reports in nondialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected.
AB - OBJECTIVE We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabe¬tes and end-stage kidney disease (ESKD). RESEARCH DESIGN AND METHODS This was a nationwide, retrospective study of adults (S18 years old) with diabetes/ ESKD, from the United States Renal Data System registry, between 2013 and 2017. Pri¬mary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1,000 per¬son-years. Event rates and risk factors were adjusted for patient age, sex, race/ethnic¬ity, dialysis modality, comorbidities, treatment regimen, and U.S. region. RESULTS Among 521,789 adults with diabetes/ESKD (median age 65 years [interquartile range 73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1,000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, respectively, the risks decreased with age and were lowest in older patients (S75 vs. 18-44 years old: Incidence rate ratio 0.35, 95% CI 0.33-0.37, and 0.03, 0.02-0.03), women (1.09, 1.06-1.12, and 1.44, 1.35-1.54), and those with smoking (1.36, 1.28-1.43, and 1.71, 1.53-1.91), substance abuse (1.27, 1.15-1.42, and 1.53, 1.23-1.9), retinopathy (1.10, 1.06-1.15, and 1.36, 1.26-1.47), and insulin therapy (vs. no therapy; 0.60, 0.59-0.63, and 0.44, 0.39-0.48). For hypoglycemia, specifically, additional risk was conferred by Black race (1.11, 1.08-1.15) and amputation history (1.20, 1.13-1.27). CONCLUSIONS In this nationwide study of patients with diabetes/ESKD, hypoglycemic crises were threefold more common than hyperglycemic crises, greatly exceeding national reports in nondialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected.
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U2 - 10.2337/dc21-1579
DO - 10.2337/dc21-1579
M3 - Article
C2 - 34740910
AN - SCOPUS:85123289525
VL - 45
SP - 100
EP - 107
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 1
ER -