More People Dying From Hyperglycemic Crises in US

Between 1999 and 2019, the mortality rate of hyperglycemic crises nearly doubled.

The entrance to the emergency department at Peter Lougheed hospital is pictured in Calgary on Aug. 22, 2023. THE CANADIAN PRESS/Jeff McIntosh

An analysis of hyperglycemic crises in the United States shows that more Americans with diabetes died from the events than previously thought.

A hyperglycemic crisis occurs when an individual, typically someone with diabetes, has critically high blood sugar. This happens when the body lacks enough insulin or can’t use it properly. Hyperglycemia can become a serious problem if left untreated. Hyperglycemia can cause people with diabetes to fall into a life-threatening state called ketoacidosis. The body can’t use sugar during ketoacidosis, so it breaks down fats for fuel. In the process of ketoacidosis, the body produces ketones as a byproduct, which can build up in the body and make the blood dangerously acidic.

While reports found the mortality rate of cardiovascular-related deaths in diabetes patients decreased between 1999 and 2019, researchers in this recent analysis, appearing in a JAMA research letter, found the trend for hyperglycemic events to be the opposite. Between 1999 and 2019, the mortality rate of hyperglycemic crises increased from 3,306 deaths per 100,000 people to 6,051 per 100,000. The mortality rate was highest in adults 65 and older, followed by adults between the ages of 45 and 64.

Researchers found that the mortality rate was particularly high during the COVID-19 crisis, peaking in 2021 at 10,230 deaths.

During the pandemic, patients often unable to access health care stopped going for regular lab tests. Securing medical supplies became more difficult. For many, the convenience of having groceries and fast food delivered to the doorstep replaced cooking nutritious meals. Exercising at the gym was a thing of the past.

Even before the pandemic, the U.S. mortality rate for diabetes patients, in particular, was grim. A 2018 study published in The Lancet gave the United States a 62 out of 100 for quality of diabetes care, scoring it behind Libya, Iran, and Vietnam. Most other Western countries scored in the 90s. According to the Organization for Economic Cooperation and Development, hospitalization rates for diabetes in the United States were 50 percent higher than in most other industrialized countries in 2019.

Some Populations Suffer More Than Others

The research team believes mortality rates increased partially as a result of inadequate preventative care, which disproportionally affected disadvantaged populations. For example, a study from 2016 found that black patients experienced higher rates of hyperglycemia and diabetes. Furthermore, black Americans have almost a twofold higher incidence of Type 2 diabetes than whites and often have more trouble with managing their glucose. Blacks also tend to experience more complications with their diabetes, such as amputations, chronic kidney disease, and retinopathy. Part of the reason could be that blacks have been observed to receive lower-quality health care, even before the pandemic.

The analysis comes on the heels of new recommendations for preventing, diagnosing, and treating adults with severe high blood glucose. The guidelines were drafted due to the emergence of some troubling statistics. According to the U.S. Centers for Disease Control and Prevention (CDC), in 2020, roughly 16.8 million emergency department visits occurred as a result of issues with diabetes; 267,000 of these visits were hyperglycemic crises, 240,000 were for diabetic ketoacidosis, and 202,000 were for adults experiencing hypoglycemia. Between 2014 and 2018, emergency departments experienced a 21 percent increase in visits from patients with diabetes.

The new guidelines, established during a conference in Germany, work to educate both patients and providers to prevent recurrent hyperglycemic crises, such as diabetic ketoacidosis.

Discharge planning also plays a vital role in reducing the mortality rate. Before a patient leaves the hospital after a hyperglycemic crisis, providers should ensure they have enough insulin and a reliable way to measure their blood glucose levels. Additionally, patients must have long-term and immediate plans of action should they become hyperglycemic again.