SUN-577 - Predictors and Outcomes of in-Hospital Hypoglycemia in Older Adults with Type 2 Diabetes: A Nationwide Analysis

Background:
Older adults with type 2 diabetes (T2D) are particularly vulnerable to hypoglycemia during hospitalization, yet national data describing its predictors and clinical impact are limited. We evaluated the prevalence, predictors, and outcomes associated with hypoglycemia among hospitalized older adults with T2D in the United States.

Methods:
We conducted a retrospective cross-sectional analysis of the National Inpatient Sample (2016–2021). Hospitalizations among adults aged ≥65 years with T2D were identified using ICD-10 codes; admissions with type 1 diabetes were excluded. Hypoglycemia was defined using ICD-10 diagnosis codes. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS) and total hospitalization charges. Multivariable regression models were used to assess associations between hypoglycemia and outcomes, adjusting for demographics, socioeconomic status, insurance payer, comorbidity burden, acute kidney injury (AKI), markers of critical illness, and calendar year. Independent predictors of hypoglycemia were also evaluated. Effect modification by AKI was assessed using interaction terms and predicted probabilities.

Results:
Among an estimated 10,060,423 hospitalizations of older adults with T2D, hypoglycemia occurred in 6.54% (95% CI 6.49–6.60). Unadjusted in-hospital mortality was higher in admissions with hypoglycemia compared with those without (2.84% vs 2.31%, p< 0.001). After adjustment, hypoglycemia remained independently associated with increased in-hospital mortality (adjusted odds ratio 1.27, 95% CI 1.22–1.33) and longer LOS (+0.44 days, p< 0.001), while being associated with lower total charges (−9.0%, p< 0.001). Independent predictors of hypoglycemia included liver disease, congestive heart failure, AKI, anemia, and chronic obstructive pulmonary disease. Hypoglycemia increased adjusted mortality both in the absence and presence of AKI.

Conclusions:
In hospitalized adults aged ≥65 years with T2D, hypoglycemia is common and independently associated with higher in-hospital mortality and longer LOS. Identification of high-risk phenotypes may support targeted inpatient glycemic safety strategies in older adults.

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