Temporal trends and clinical factors associated with hypoglycemia-related hospitalization of patients with type 2 diabetes: a large-scale claims database study in Japan.

AIMS: Severe hypoglycemia is an important adverse event in type 2 diabetes, particularly among older adults and clinically vulnerable patients. However, recent real-world trends in hypoglycemia requiring hospitalization in Japan are insufficiently characterized.

METHODS

We conducted a retrospective cross-sectional study by using Japanese hospital-based claims data for 2009-2022. Patients receiving glucose-lowering medications for type 2 diabetes were included (N = 1,391,948). The primary outcome was hospitalization for hypoglycemia, defined using codes for diagnosis, same-day hospitalization, and intravenous administration of 50% glucose. Secondary outcomes were nocturnal hospitalization and the requirement of emergency transport. Annual frequencies were described, and adjusted risk ratios were estimated using modified Poisson regression analysis.

RESULTS

Overall, 7,157 patients were hospitalized for hypoglycemia. The annual frequency decreased from 0.41% in 2009 to 0.21% in 2022; the greatest decline was among patients aged ≥ 75 years, who continued to account for the majority of hospitalizations. Older age and lower body mass index were associated with all hypoglycemia-related outcomes, as were insulin, pioglitazone, glucagon-like peptide-1 receptor agonists, alpha-glucosidase inhibitors, and sulfonylureas. In the sensitivity analysis, impaired kidney function was associated with an increased risk.

CONCLUSIONS

Hypoglycemia-related hospitalization declined in Japan during 2009-2022, with the residual burden remaining concentrated among older adults.