Hospital-Treated Severe Hypoglycemia in Type 1 Diabetes in the US: A Retrospective Claims-Based Study of Diabetes-Related Complications and Direct Medical Costs.

INTRODUCTION

Severe hypoglycemic events (SHEs) impose substantial clinical and economic burden on people with type 1 diabetes (pwT1D), yet real-world data describing this burden remain limited in the U.S. hospital setting. This study examined T1D-related complications and direct medical costs in pwT1D hospitalized or treated in the emergency department (ED) for hypoglycemia.

METHODS

IQVIA's PharMetrics Plus database was used to identify adults with T1D who experienced at least 1 hypoglycemic event requiring an inpatient hospitalization or ED visit from April 2016-April 2020. The SHE date was defined as the date of the first hospital-treated SHE: a claim with a hypoglycemia diagnosis and an inpatient hospitalization or ED visit. Patients were followed up until the end of continuous enrollment or end of the study period (April 30, 2022). Prevalence of T1D-related complications were descriptively summarized, and all-cause direct medical costs were calculated as per-patient-per-year (PPPY). The study was conducted during a period of early adoption of advanced diabetes technologies, such as hybrid closed-loop systems, and only included direct medical costs, potentially underestimating total costs.

RESULTS

Among 4627 adults with T1D and hospital-treated SHEs, mean age was 41.4 years, 57.3% were male, and 93.4% had commercial insurance. Common comorbidities included hypertension (24.6%), anxiety (9.5%), and depression (9.3%). Prevalence of retinopathy, neuropathy, chronic kidney disease (any stage), coronary artery disease, and peripheral vascular disease were 38.6%, 38.6%, 17.7%, 13.2%, and 11.4%, respectively. Total all-cause direct medical costs averaged $52,849 PPPY in 2022 USD ($59,719 in 2025 USD), driven primarily by inpatient hospitalization (mean-$22,981 in 2022 USD, $25,968 in 2025 USD). Among patients with a hospitalization, mean (SD) number of hospitalizations (PPPY) were 1.5 (3.6) and the average length of stay per patient (PPPY) was 5.0 (20.7) days.

CONCLUSION

High T1D-related complication rates and elevated direct medical costs highlight the complexity of pwT1D who experienced hospital-treated SHEs.