title: Trends in Emergency Department Visit Rates for Hypoglycemia and Hyperglycemic Crisis among Adults with Diabetes, United States, 2006-2011.
abstract: BACKGROUND
  Despite concerns about hypoglycemia events from overly aggressive glycemic reduction, population trends in hypoglycemia and hyperglycemic crisis incidence are unclear. To address this gap, we examined changes in emergency department (ED) visit rates for hypoglycemia and hyperglycemic crisis 2006-2011.
  
  
  METHODS
  Using data from the Nationwide Emergency Department Sample, we estimated the number of ED visits for hypoglycemia and hyperglycemic crisis via ICD-9-CM among adults with diabetes. Using data from the National Health Interview Survey, we estimated the population of adults with diabetes and calculated ED visit rates.
  
  
  RESULTS
  From 2006 to 2011, ED visit rates for hypoglycemia declined by 22% from 1.8 to 1.4 per 100 adults (p = 0.003). The rates decreased in all age groups (all P<0.05) except those aged 18 to 44 years (P = 0.31). Hypoglycemia rates displayed a J-shaped curve across age, with the highest rates among adults aged 75 years or older (P <0.001). ED visit rates for hyperglycemic crisis did not change overall but increased 17% for adults aged 65 to 74 years (P = 0.02) and 29% for women (P = 0.01). Hyperglycemic crisis rates were highest among adults aged 18 to 44 years (P <0.001).
  
  
  CONCLUSIONS
  Hypoglycemia rates have declined for all adults but persons aged 18-44 years while rates for hyperglycemic crisis remained stable. Future preventive efforts should target on the susceptible population of adults aged 18 to 44 years and those aged 75 years or older.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000453:epidemiology*; D007003:Hypoglycemia / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult