Diabetes and Kidney Disease: Managing Hypoglycemia and Hyperglycemia Crises in US Adults (2013-2017)

What is it about?

This study investigated annual trends of severe hypoglycemic and hyperglycemic crises in patients with diabetes and end-stage kidney disease (ESKD) in the United States. The primary outcome was the annual rate of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises per 1,000 person-years. The study found that both hypoglycemic and hyperglycemic crises were common, with rates of severe hypoglycemia being almost three times higher than rates of hyperglycemia. The risk of both crises decreased with age, and women and young, Black patients experienced a disproportionate burden of both crises. The study adds nationally representative data for a diverse population of patients on maintenance dialysis, allowing for the identification of key geographic, demographic, and clinical subgroups of patients at highest risk. The reported rates of severe hypoglycemia are higher than previous reports for high-risk populations, and the study emphasizes the need for timely identification of individuals at risk and prevention of these potentially fatal events.

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Why is it important?

This research is important because it provides nationwide data on the annual rates of severe hypoglycemic and hyperglycemic crises in patients with diabetes and end-stage kidney disease (ESKD). The study highlights the burden of these events and identifies high-risk subgroups, which can inform targeted prevention strategies. Additionally, the study emphasizes the need for better glycemic control and management in this population, as well as the importance of timely identification of individuals at risk and prevention of potentially fatal events. Key Takeaways: 1. Severe hypoglycemic and hyperglycemic crises are common in patients with diabetes and ESKD, with rates of severe hypoglycemia being almost threefold higher than rates of hyperglycemia. 2. Young, Black patients, and women experience a disproportionate burden of both crises. 3. Risk factors for both glycemic crises include treatment with insulin, smoking, substance abuse, and retinopathy. 4. The reported rates of severe hypoglycemia are higher than previous reports for high-risk populations. 5. Optimized glycemic monitoring, such as continuous glucose monitoring, can prevent hypoglycemic and hyperglycemic crises requiring ED or hospital care. 6. High-risk diabetes/ESKD patients would benefit from greater availability of Certified Diabetes Care and Education Specialists and multidisciplinary clinics that incorporate CDCES and/or clinical pharmacists.