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Identifying the Risks of a Hyperglycemic Crisis

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Identifying the Risks of a Hyperglycemic Crisis

Diabetes experts call it “hyperglycemia.” The rest of us usually just refer to it as high blood sugar or high blood glucose. But whatever it’s called, it can be dangerous, with chronic high blood glucose leading to complications such as neuropathy (nerve damage), retinopathy (damage to the retina in the eye), nephropathy (kidney damage), strokes, heart attacks, and more. In acute situations, when left untreated, it can also cause diabetic coma.

As specialists learn more and more about hyperglycemia, they are discovering that some people with diabetes are more likely to experience the condition than others. Now, a new report published in JAMA Network Open has identified factors that might enable health care providers to identify subjects at high risk.

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The research team, which was headed by Rozalina G. McCoy, MD, of the Mayo Clinic in Rochester, Minnesota, retrieved their data from the OptumLabs Data Warehouse, a collaborative effort between the University of California and OptumLabs that collects anonymous data on 160 million claims and clinical information (OptumLabs is a collaborative center for research and innovation in health care with headquarters in Cambridge, Massachusetts). The data contained information on over 20,000 patients with type 1 diabetes and some 800,000 with type 2. The average age of the type 2 patients was about 65; the male/female split was about 50/50 and a little more than half were white. The type 1 group was younger (average age 46.6) and included more white subjects (72.6%) and also about equally divided between male and female.

A variety of conditions linked to the development of hyperglycemic crises

The top factor in predicting a hyperglycemic crisis was a prior history of hyperglycemic crises, including two conditions: One was diabetic ketoacidosis, which arises when the body doesn’t produce enough insulin, causing the liver to produce acids called ketones, a build-up of which can be dangerous. The second was a hyperglycemic hyperosmolar state (HHS), which can occur when blood sugar levels remain high for a long time. It’s a serious disorder that can, if not treated, lead to seizures, organ failure, coma, and even death. Interestingly, the researchers found that the likelihood of a hyperglycemic crisis among people who’d had diabetic ketoacidosis or a hyperglycemic hyperosmolar state was greater in people with type 2 diabetes than with type 1.

Second on the list was a high A1C level (a measure of long-term glucose control), above 10%. Both people with type 1 and type 2 who had high A1C levels had a seven-fold higher risk of a hyperglycemic crisis. Third was low blood sugar, also called hypoglycemia, a condition in which blood sugar levels fall too low (in general, for people with diabetes this is considered to be a blood sugar level below 70 mg/dl). This risk was determined to be higher for those with type 2 diabetes.

The next crisis-related conditions were found to be neuropathy, nephropathy, and depression. The researchers found no other conditions that were related to hyperglycemic crisis in people with type 1 diabetes, but they found several more that affected those with type 2: retinopathy; cerebrovascular disease; peripheral vascular disease; heart failure; dementia; chronic obstructive pulmonary disease, or COPD (a chronic lung disease that makes it difficult to breathe); cancer; and cirrhosis. They also discovered two more factors that raised the risk of hyperglycemic crisis in type 2 diabetes patients only: being on an SGLT2 inhibitor (a class of diabetes drugs) or taking insulin. Finally, the researchers discovered that the rates of hyperglycemic crises increased over time among people with type 1 diabetes, but not among those with type 2.

The authors also looked at social and demographic issues. They reported, for example, that Black people with diabetes were more likely to have a hyperglycemic crisis than white people. Also, younger people (18-44) were at higher risk than middle-aged and older ones. Finally, income played a role. People making $200,000 a year or more had a much lower risk of a hyperglycemic crisis than those earning less than $40,000 a year. The researchers speculated that this discrepancy arose because poorer people were more likely to lack insurance and to ration their doses of insulin. This finding, they wrote, supports “the need for policies and systems to ensure improved access to affordable glucose-lowering therapies.”

More generally, the authors concluded their report by saying, “Health care delivery systems should incorporate educational, clinical, and social support systems into clinical practice, and payers should consider expanding reimbursement for self-management education and social services as well as more comprehensive coverage for glucose-lowering medications, insulin, and glucose-monitoring technologies.”

Want to learn more about hyperglycemic crises? Read “DKA: What to Know and How to Deal” and “Hyperglycemic Crises: What They Are and How to Avoid Them.”

Joseph Gustaitis

Joseph Gustaitis

Joseph Gustaitis on social media

A freelance writer and editor based in the Chicago area, Gustaitis has a degree in journalism from Columbia University. He has decades of experience writing about diabetes and related health conditions and interviewing healthcare experts.

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