2978-LB: Annual Prevalence of Diabetic Ketoacidosis and Severe Hypoglycemia in Type 2 Diabetes

Introduction and Objective: Diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) require costly, high-intensity acute care. Recent trends in type 2 diabetes (T2D) are not well described. We estimated annual prevalence of DKA and SH requiring emergency department (ED) or inpatient (IP) care among people with T2D. Methods: We analyzed Inovalon Insights claims (2017-2024) from Commercial, Managed Medicaid, and Medicare Advantage plans. ED visits with subsequent admission were solely counted as IP episodes. Prevalence was defined as proportion of individuals with T2D with ≥1 event in a calendar year. Estimates were reported overall and stratified by pediatric (18y/o) vs. adult and setting (ED/IP). Primary analyses required DKA/SH in the primary diagnosis position using ICD 10 codes; sensitivity analyses included any diagnosis position. Results: DKA prevalence increased from 18 to 32 per 10,000 overall (pediatric 13 to 36; adult 18 to 32). SH prevalence remained lower and stable overall (0.61 to 0.55 per 10,000) and in adults (0.63 to 0.55 per 10,000). Yet, in pediatrics SH increased (0.10 to 0.60 per 10,000). Most events were managed IP: DKA (peds 94%, adults 98%) and SH (peds 58% and adults 90%). Sensitivity analyses yielded higher DKA prevalence with similar temporal and age-group patterns; SH prevalence remained low. Conclusion: In contrast to SH, DKA prevalence increased in T2D, with the largest rise in youth. This suggests more must be done to address DKA in people with T2D. Disclosure C. Wysham: Advisory Panel; Current; Abbott Diabetes. Speaker's Bureau; Current; Abbott Diabetes. Research Support; Ended; AbbVie Inc., Bayer AG, Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Advisory Panel; Current; Eli Lilly and Company. Research Support; Ended; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Stock/Shareholder; Current; Pendulum. Speaker's Bureau; Ended; MannKind Corporation. J. Sherr: Other - research support, consultant, advisory board member; Current; Abbott Diabetes. Other - advisory board member, consultant; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Ypsomed AG. Research Support; Current; Dexcom, Inc., JDRF, Provention Bio, Inc., National Institutes of Health. Other - research support, consultant, advisory board member; Current; Insulet Corporation, Medtronic. Research Support; Current; Sanofi. Advisory Panel; Current; sequel med tech. S. Mehta: Employee; Current; Abbott Diabetes. N. Virdi: Employee; Current; Abbott Diabetes.