Coexisting Conditions and Complications

Emergency Department Visits

In 2016, a total of 16 million emergency department (ED) visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older (Table 5), including:

  • 224,000 for hyperglycemic crisis (9.7 per 1,000 adults with diabetes).
  • 235,000 for hypoglycemia (10.2 per 1,000 adults with diabetes).
Table 5. Number and rate of emergency department visits per 1,000 adults aged 18 years or older with diabetes for selected causes, United States, 2016
Risk Factor Number in thousands Crude rate per 1,000 (95% CI)
Diabetes as any listed diagnosis 15,965 69.1 (63.3–74.9)
Hyperglycemic crisis 224 9.7 (8.9–10.5)
   Diabetic ketoacidosis 203 8.8 (8.0–9.5)
   Hyperosmolar hyperglycemic syndrome 21 0.9 (0.85–1.0)
Hypoglycemia 235 10.2 (9.4–11.0)

In 2016, of the ED visits with diabetes as any listed diagnosis among US adults aged 18 years or older, disposition data (See Detailed Methods) indicated:

  • 59.0% were treated and released; 35.1% were admitted to the hospital; 2.3% were transferred to another hospital; 2.2% 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 0.2% had unknown disposition but were not admitted to a hospital.
  • Of those ED visits involving hypoglycemia, 71.0% were treated and released, 22.3% were admitted to the hospital, and <0.1% died.
  • Of the ED visits involving hyperglycemic crisis, 8.1% were treated and released, 85.6% were admitted to the hospital, and <0.1% died.

Hospitalizations

In 2016, a total of 7.8 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older (339.0 per 1,000 adults with diabetes) (Table 6). These discharges included:

  • 1.7 million for major cardiovascular diseases (75.3 per 1,000 adults with diabetes), including:
    • 438,000 for ischemic heart disease (18.9 per 1,000 adults with diabetes).
    • 313,000 for stroke (13.6 per 1,000 adults with diabetes).
  • 130,000 for a lower-extremity amputation (5.6 per 1,000 adults with diabetes).
  • 209,000 for hyperglycemic crisis (9.1 per 1,000 adults with diabetes).
  • 57,000 for hypoglycemia (2.5 per 1,000 adults with diabetes).
Table 6. Number and rate of hospitalizations per 1,000 adults aged 18 years or older with diabetes for selected causes, United States, 2016
Risk Factor Number in thousands Crude rate per 1,000 (95% CI)
Diabetes as any listed diagnosis 7,833 339.0 (317.6–360.4)
Major cardiovascular disease 1,740 75.3 (70.4–80.2)
   Ischemic heart disease 438 18.9 (17.6–20.2)
   Stroke 313 13.6 (12.7–14.5)
Lower-extremity amputation 130 5.6 (5.3–6.0)
Hyperglycemic crisis 209 9.1 (8.5–9.6)
   Diabetic ketoacidosis 188 8.1 (7.6–8.7)
   Hyperosmolar hyperglycemic syndrome 21 0.9 (0.85–1.0)
Hypoglycemia 57 2.5 (2.3–2.6)

Kidney Disease (See Detailed Methods)

  • Among U.S. adults aged 20 years or older with diagnosed diabetes, the estimated crude prevalence of chronic kidney disease (stages 1–4) was 36.5% (95% CI, 32.2%–40.8%) during 2011–2012.2
  • Among those with diabetes and moderate to severe kidney disease (stage 3 or 4), 19.4% (95% CI, 15.5%–23.2%) were aware of their kidney disease during 1999–2012.3
  • In 2014, a total of 52,159 people developed end-stage renal disease with diabetes as the primary cause. Adjusted for age group, sex, and racial or ethnic group, the rate was 154.4 per 1 million persons.4

Among US adults aged 18 years or older with diagnosed diabetes, crude estimates for 2013–2016 were:

  • 37.0% (95% CI, 33.0%–41.2%) had chronic kidney disease (stages 1–4), of which over half (52.5%) had moderate to severe chronic kidney disease (stage 3 or 4).
  • 24.9% (95% CI, 19.4%–31.4%) with moderate to severe chronic kidney disease (stage 3 or 4) were aware of their kidney disease.

In 2017:

  • Crude prevalence of end-stage kidney disease with diabetes listed as the primary cause was 38.6% (288,451 out of 746,557 people). Consequently, diabetes was the leading cause of end-stage kidney disease, followed by high blood pressure (25.9%), and glomerulonephritis (15.5%).
  • Crude incidence of end-stage kidney disease with diabetes as the primary cause was 180.3 per 1 million population (58,372 new cases).

Vision Disability (See 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 2018 indicated:
    • 11.7% (95% CI, 11.0%–12.5%) reported vision disability, including blindness.

Deaths4

  • In 2017, diabetes was the seventh leading cause of death in the United States. This finding is based on 83,564 death certificates in which diabetes was listed as the underlying cause of death (crude rate, 25.7 per 100,000 persons).
  • In 2017, there were 270,702 death certificates with diabetes listed as the underlying or contributing cause of death (crude rate, 83.1 per 100,000 persons).

Costs5

  • 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).
Page last reviewed: July 21, 2020