Trends, burden, and outcomes of hypoglycemia hospitalizations in older adults: a territory-wide study in Hong Kong, 2012-2021.

BACKGROUND

Severe hypoglycemia is typically regarded as a temporary metabolic issue in diabetes management. We aimed to examine trends, clinical outcomes, and post-hypoglycemia comorbidity patterns among hospitalized older adults, regardless of diabetes status.

METHODS

This population-based cohort study analyzed 4,832,869 hospitalizations of older adults (≥65 years) in Hong Kong (2012-2021). We assessed annual hypoglycemia hospitalization rates, using 1:2 propensity score matching to compare outcomes between 14,879 cases and 29,758 controls, and applied network analysis to characterize post-hypoglycemia comorbidity phenotypes. Outcomes included all-cause mortality, hospital readmissions, and cumulative length of stay (LOS).

RESULTS

Hypoglycemia hospitalization rates more than doubled from 2.77 to 5.17 per 1,000 episodes (2012-2015) before plateauing, coinciding with a shift toward unspecified diagnostic coding. Hypoglycemia was associated with significantly increased mortality (HR=2.149, 95 % CI: 2.061-2.241), readmission rates (IRR=2.019, 95 % CI: 1.970-2.069), and LOS (IRR=2.098, 95 % CI: 2.030-2.169). Network analysis identified three communities: Neuro-Metabolic-Respiratory Syndrome (dominant community), Cardiorenal-Vascular Degeneration Axis (network hub), and Gastro-Oncological & Traumatic group (peripheral community). Patient stratification revealed four phenotypes: Gastro-Oncological-dominant patients had the poorest survival; Neuro-Metabolic-Respiratory patients showed the highest frailty; Cardiorenal-Vascular patients experienced multisystem organ dysfunction; and Complex Multi-Morbidity patients had preserved survival but higher healthcare utilization.

CONCLUSIONS

Severe hypoglycemia in older adults signals accelerated multimorbidity accumulation rather than being an isolated metabolic issue. Comorbidities form distinct phenotypes that enable targeted risk stratification and intervention. This necessitates viewing severe hypoglycemia as a critical transition point for comprehensive geriatric vulnerability assessment and informed care planning, irrespective of diabetes status.