Table 2. Risk Factors of Severe Hypoglycemia and Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Statea.
| Variable | Hypoglycemia | DKA or HHS | ||
|---|---|---|---|---|
| IRR (95% CI) | P value | IRR (95% CI) | P value | |
| % White residents in county | 0.67 (0.62-0.72) | <.001 | 0.80 (0.67-0.95) | .01 |
| ADI quintile | ||||
| Q1 (least deprivation) | 1 [Reference] | 1 [Reference] | ||
| Q2 | 1.01 (0.94-1.09) | .84 | 1.02 (0.94-1.11) | .61 |
| Q3 | 1.12 (1.03-1.22) | .009 | 1.14 (1.04-1.24) | .003 |
| Q4 | 1.15 (1.05-1.27) | .004 | 1.12 (1.02-1.24) | .02 |
| Q5 (most deprivation) | 1.41 (1.29-1.54) | <.001 | 1.12 (1.00-1.25) | .049 |
| Sex | ||||
| Female | 1 [Reference] | 1 [Reference] | ||
| Male | 0.93 (0.90-0.96) | <.001 | 0.92 (0.88-0.97) | .002 |
| Health plan | ||||
| Commercial | 1 [Reference] | 1 [Reference] | ||
| Medicare Advantage | 2.40 (2.24-2.57) | <.001 | 1.82 (1.68-1.98) | <.001 |
| Age category, y | ||||
| 18-44 | 1 [Reference] | 1 [Reference] | ||
| 45-64 | 0.79 (0.72-0.86) | <.001 | 0.35 (0.32-0.38) | <.001 |
| 65-74 | 0.66 (0.60-0.73) | <.001 | 0.15 (0.13-0.16) | <.001 |
| ≥75 | 0.83 (0.76-0.92) | <.001 | 0.12 (0.11-0.13) | <.001 |
| Glucose-lowering medications | ||||
| No pharmacy fills | 0.68 (0.64-0.72) | <.001 | 0.77 (0.70-0.84) | <.001 |
| Insulin | ||||
| Basal human | 2.27 (2.04-2.53) | <.001 | 1.45 (1.23-1.72) | <.001 |
| Basal analog | 2.00 (1.92-2.08) | <.001 | 1.77 (1.66-1.88) | <.001 |
| Bolus human | 1.81 (1.63-2.01) | <.001 | 1.86 (1.58-2.20) | <.001 |
| Bolus analog | 2.36 (2.26-2.46) | <.001 | 2.53 (2.35-2.73) | <.001 |
| DPP-4 inhibitors | 0.84 (0.79-0.88) | <.001 | 0.84 (0.77-0.92) | <.001 |
| GLP-1 receptor agonists | 0.66 (0.61-0.71) | <.001 | 0.71 (0.63-0.79) | <.001 |
| Metformin | 0.57 (0.55-0.59) | <.001 | 0.55 (0.51-0.58) | <.001 |
| SGLT2 inhibitors | 0.70 (0.63-0.77) | <.001 | 1.25 (1.12-1.40) | <.001 |
| Sulfonylurea | 1.68 (1.61-1.75) | <.001 | 0.92 (0.86-0.99) | .02 |
| Thiazolidinediones | 1.02 (0.95-1.09) | .58 | 0.94 (0.82-1.08) | .36 |
| Other medicationsb | 1.08 (0.87-1.34) | .49 | 0.95 (0.57-1.61) | .86 |
| Glucagon | 1.87 (1.66-2.10) | <.001 | 1.75 (1.53-2.00) | <.001 |
| Diabetes complications and other comorbidities | ||||
| Cardiovascular disease | 1.21 (1.17-1.25) | <.001 | 0.93 (0.87-0.98) | .01 |
| Cancer | 1.00 (0.95-1.05) | .91 | 0.89 (0.80-0.98) | .02 |
| Cerebrovascular disease | 1.19 (1.14-1.25) | <.001 | 1.12 (1.03-1.21) | .007 |
| Chronic pulmonary disease | 1.12 (1.08-1.16) | <.001 | 0.95 (0.89-1.01) | .08 |
| Dementia | 1.10 (1.02-1.18) | .01 | 1.21 (1.08-1.36) | .002 |
| DKA or HHS | 3.21 (2.80-3.69) | <.001 | 22.48 (20.23-24.97) | <.001 |
| Metastatic cancer | 1.34 (1.18-1.51) | <.001 | 1.23 (0.98-1.55) | .08 |
| Mild liver disease | 0.99 (0.93-1.06) | .87 | 1.07 (0.97-1.18) | .20 |
| Moderate or severe liver disease | 1.70 (1.45-1.99) | <.001 | 1.17 (0.92-1.50) | .20 |
| Nephropathy | 1.53 (1.47-1.58) | <.001 | 1.22 (1.15-1.29) | <.001 |
| Neuropathy | 1.35 (1.31-1.40) | <.001 | 1.41 (1.34-1.49) | <.001 |
| Peripheral vascular disease | 1.15 (1.11-1.20) | <.001 | 1.03 (0.96-1.11) | .42 |
| Retinopathy | 1.40 (1.35-1.45) | <.001 | 1.22 (1.14-1.30) | <.001 |
| Severe hypoglycemia | 7.57 (7.02-8.16) | <.001 | 4.04 (3.58-4.57) | <.001 |
Abbreviations: ADI, area deprivation index; DKA, diabetic ketoacidosis; DPP-4, dipeptidyl-peptidase 4; GLP-1, glucagon-like peptide-1; HHS, hyperglycemic hyperosmolar state; IRR, incidence rate ratio; SGLT2, sodium-glucose cotransporter 2.
a
Results of negative binomial regression models were adjusted for all variables shown.
b
Other glucose-lowering medications included glinides, amylin analogs, and α-glucosidase inhibitors.