● Hypoglycemia admissions raised in 2012–2015 then plateaued; burden beyond diabetes. ● Severe hypoglycemia doubled the risk of mortality, readmission, and hospital stays. ● Post-hypoglycemia morbidity forms distinct phenotypes enabling targeted care. 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. 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). 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 cluster), Cardiorenal-Vascular Degeneration Axis (network hub), and Gastro-Oncological Neuro-Metabolic-Respiratory patients showed the highest frailty; Cardiorenal-Vascular patients experienced multisystem decline; and Complex Multi-Morbidity patients had preserved survival but higher healthcare utilization. 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.
Yu et al. (Sun,) studied this question.