Coexisting Conditions and Complications

Emergency Department Visits

In 2018, approximately 17 million emergency department (ED) visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older (Table 5), including:

• 248,000 for hyperglycemic crisis (9.9 per 1,000 adults with diabetes).
• 242,000 for hypoglycemia (9.6 per 1,000 adults with diabetes).

In 2018, of the ED visits with diabetes as any listed diagnosis among US adults aged 18 years or older, disposition data (See Appendix B: Detailed Methods and Data Sources) indicated:

• 58.6% were treated and released; 35.5% were admitted to the hospital; 2.1% were transferred to another hospital; 2.5% were transferred to a skilled nursing facility, intermediate care facility, or home with home health care; 1.1% left against medical advice; 0.2% died; and 0.1% had unknown disposition but were not admitted to a hospital.
• Of those ED visits involving hypoglycemia, 70.1% were treated and released, 23.1% were admitted to the hospital, and <0.1% died.
• Of the ED visits involving hyperglycemic crisis, 8.4% were treated and released, 85.5% were admitted to the hospital, and <0.1% died.

Hospitalizations

In 2018, a total of 8.25 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older (327.9 per 1,000 adults with diabetes) (Table 6). These discharges included:

• 1.87 million for major cardiovascular diseases (74.4 per 1,000 adults with diabetes), including:
  • 440,000 for ischemic heart disease (17.5 per 1,000 adults with diabetes).
  • 334,000 for stroke (13.3 per 1,000 adults with diabetes).
• 154,000 for a lower-extremity amputation (6.1 per 1,000 adults with diabetes).
• 226,000 for hyperglycemic crisis (9.0 per 1,000 adults with diabetes).
• 60,000 for hypoglycemia (2.2 per 1,000 adults with diabetes).

Kidney Disease (See Appendix B: Detailed Methods)

Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2017–2020 shown in Appendix Table 11 indicated:

• 39.2% had chronic kidney disease (CKD, stages 1–4), based on the updated 2021 CKD Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR).
  • 15.7% had moderate to severe CKD (stage 3 or 4).
  • 23.1% of non-Hispanic Black adults, 17.2% of non-Hispanic White adults, and 8.9% of Hispanic adults had moderate to severe CKD (stage 3 or 4).
  • 32.5% with moderate to severe CKD (stage 3 or 4) were aware of their kidney disease.
• 40.9% had chronic kidney disease (CKD, stages 1–4), based on the 2009 CKD-EPI eGFR equation.

In 2018:

• A total of 62,012 people developed end-stage kidney disease with diabetes as the primary cause.
• Crude incidence of end-stage kidney disease with diabetes as the primary cause was 189.8 per 1 million population (62,012 new cases). Adjusted for age group, sex, and racial or ethnic group, the rate was 180.3 per 1 million persons.
• Crude prevalence of end-stage kidney disease with diabetes listed as the primary cause was 38.8% (305,013 out of 785,883 people). Consequently, diabetes was the leading cause of end-stage kidney disease, followed by high blood pressure (26.1%), and glomerulonephritis (14.9%).

Vision Disability (See Appendix B: Detailed Methods)

• Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years.
• Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2019 indicated:
  • 11.8% (95% CI, 11.1%–12.4%) reported severe vision difficulty or blindness.

Deaths⁵

• In 2019, diabetes was the seventh leading cause of death in the United States. This finding is based on 87,647 death certificates in which diabetes was listed as the underlying cause of death (crude rate, 26.7 per 100,000 persons).
• In 2019, there were 282,801 death certificates with diabetes listed as the underlying or contributing cause of death (crude rate, 86.2 per 100,000 persons).

Costs⁶

• The total direct and indirect estimated costs* of diagnosed diabetes in the United States in 2017 was $327 billion.
• Total direct estimated costs of diagnosed diabetes increased from $188 billion in 2012 to $237 billion in 2017 (2017 dollars); total indirect costs increased from $73 billion to $90 billion in the same period (2017 dollars).
• Between 2012 and 2017, excess medical costs per person associated with diabetes increased from $8,417 to $9,601 (2017 dollars).

* Direct costs = medical costs; indirect costs = lost productivity from work-related absenteeism, reduced productivity at work and at home, unemployment from chronic disability, and premature mortality