Temporal trends and clinical factors associated with hypoglycemia-related hospitalization of patients with type 2 diabetes: a large-scale claims database study in Japan.

AIMS: Severe hypoglycemia is an important adverse event in type 2 diabetes, particularly among older adults and clinically vulnerable patients. However, recent real-world trends in hypoglycemia requiring hospitalization in Japan are insufficiently characterized. METHODS: We conducted a retrospective cross-sectional study by using Japanese hospital-based claims data for 2009-2022. Patients receiving glucose-lowering medications for type 2 diabetes were included (N = 1,391,948). The primary outcome was hospitalization for hypoglycemia, defined using codes for diagnosis, same-day hospitalization, and intravenous administration of 50% glucose. Secondary outcomes were nocturnal hospitalization and the requirement of emergency transport. Annual frequencies were described, and adjusted risk ratios were estimated using modified Poisson regression analysis. RESULTS: Overall, 7,157 patients were hospitalized for hypoglycemia. The annual frequency decreased from 0.41% in 2009 to 0.21% in 2022; the greatest decline was among patients aged ≥ 75 years, who continued to account for the majority of hospitalizations. An older age and lower body mass index were associated with all hypoglycemia-related outcomes, as were insulin, pioglitazone, glucagon-like peptide-1 receptor agonists, alpha-glucosidase inhibitors, and sulfonylureas. In the sensitivity analysis, impaired kidney function was associated with an increased risk. CONCLUSIONS: Hypoglycemia-related hospitalization declined in Japan during 2009-2022, the residual burden remaining concentrated among older adults.