Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes (EDH)

For persons 67 years of age and older with diabetes (types 1 and 2), the risk-adjusted ratio of observed to expected (O/E) emergency department (ED) visits for hypoglycemia during the measurement period. Two rates are reported:

  1. For persons 67 years of age and older with diabetes (types 1 and 2), the risk-adjusted ratio of O/E ED visits for hypoglycemia during the measurement period, stratified by dual eligibility.
  2. For persons 67 years of age and older with diabetes (types 1 and 2) who had at least one dispensing event of insulin within each 180-day (6-month) treatment period from July 1 of the year prior to the measurement period through December 31 of the measurement period, the risk-adjusted ratio of O/E ED visits for hypoglycemia, stratified by dual eligibility.

Why It Matters

The measure reports a total rate and a rate among members receiving insulin; both rates are stratified by dual eligibility status. Lower rates indicate better performance on this measure.

Patients with diabetes who experience a hypoglycemic event are at significantly higher risk of repeat severe hypoglycemic episodes, as well as other negative outcomes such as cardiovascular events (1). Common adverse events resulting from hypoglycemia include cardiovascular disease, falls and fractures, dementia, low health-related quality of life, potential risk of strokes and increased mortality (2,3,4). Hypoglycemia may be influenced by a variety of factors, including malnutrition or food insecurity, tight glycemic control and use of intensive antihyperglycemic medications (5,6,7).

According to the National Diabetes Statistics Report, in 2021 there were 192,000 ED visits for hypoglycemia in the U.S (8). Older adults with diabetes are at higher risk of hypoglycemia resulting from diabetes treatment than younger adults. A retrospective cohort study of over 160,000 patients with type 2 diabetes found the incidence rate of hypoglycemia among those 65–74 was almost twice as high compared to those 20–64, and over four times as high among those 75 and older (9).

While the consequences of hypoglycemia can be devastating in older adults, it may be possible to reduce hypoglycemia risk through effective treatment management. Multiple clinical practice guidelines recommend adjusting treatment regimens in older adults to minimize hypoglycemia risk. For example, the American Diabetes Association (ADA) recommends routine monitoring of hypoglycemic episodes and adjusting glycemic targets and pharmacologic regimens to avoid hypoglycemia in older adults (10). The Endocrine Society recommends that clinicians design outpatient diabetes regimens specifically to minimize hypoglycemia (11). The American Association of Clinical Endocrinology (AACE) cites minimizing hypoglycemia as a guiding principle in its diabetes treatment algorithm and emphasizes that reducing risk of hypoglycemia should be a key consideration when selecting antihyperglycemic agents (12).

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.

References

  1. Mellor, Joseph, Dmitry Kuznetsov, Simon Heller, et al. 2024. “Estimating Risk of Consequences Following Hypoglycaemia Exposure Using the Hypo-RESOLVE Cohort: A Secondary Analysis of Pooled Data from Insulin Clinical Trials.” Diabetologia 67 (July): 2210–24. https://doi.org/10.1007/s00125-024-06225-1
  2. Gariani, Karim, Dongryeol Ryu, and Manfredi Rizzo. 2025. “Cognitive Disorders in Diabetes.” Frontiers in Clinical Diabetes and Healthcare: 1534105. https://doi.org/10.3389/fcdhc.2025.1534105
  3. Mattishent, Katharina, and Yoon K. Loke. 2021. “Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents.” Frontiers in Endocrinology 12: 571568. https://doi.org/10.3389/fendo.2021.571568.
  4. Zheng, B., B. Su, G. Price, I. Tzoulaki, S. Ahmadi-Abhari, & L. Middleton. 2021. “Glycemic Control, Diabetic Complications, and Risk of Dementia in Patients With Diabetes: Results From a Large UK Cohort Study.” Diabetes Care.
  5. McCoy, Rozalina G., Kasia J. Lipska, Holly K. Van Houten, and Nilay D. Shah. 2020. “Association of Cumulative Multimorbidity, Glycemic Control, and Medication Use With Hypoglycemia-Related Emergency Department Visits and Hospitalizations Among Adults With Diabetes.” JAMA Network Open 3 (1): e1919099. https://doi.org/10.1001/jamanetworkopen.2019.19099.
  6. Schroeder, Emily B., Stan Xu, Glenn K. Goodrich, Gregory A. Nichols, Patrick J. O’Connor, and John F. Steiner. 2017. “Predicting the Six-Month Risk of Severe Hypoglycemia among Adults with Diabetes: Development and External Validation of a Prediction Model.” Journal of Diabetes and Its Complications 31 (7): 1158–63. https://doi.org/10.1016/j.jdiacomp.2017.04.004.
  7. Chow, Lisa S., Rachel Zmora, Sisi Ma, Elizabeth R. Seaquist, and Pamela J. Schreiner. 2018. “Development of a Model to Predict 5-Year Risk of Severe Hypoglycemia in Patients with Type 2 Diabetes.” BMJ Open Diabetes Research & Care 6 (1): e000527. https://doi.org/10.1136/bmjdrc-2018-000527.
  8. Centers for Disease Control and Prevention (CDC). 2026. “National Diabetes Statistics Report.” https://www.cdc.gov/diabetes/php/data-research/index.html
  9. Ikeda, Y., T. Kubo, E. Oda, M. Abe, & S. Tokita. “Incidence Rate and Patient Characteristics of Severe Hypoglycemia in treated Type 2 Diabetes Mellitus Patients in Japan: Retrospective Diagnosis Procedure Combination Database Analysis.” Journal of Diabetes Investigation 9, no. 4 (2018): 925–36. https://doi.org/10.1111/jdi.12778
  10. American Diabetes Association Professional Practice Committee for Diabetes. 2026. “13. Older Adults: Standards of Care in Diabetes—2026.” Diabetes Care 49, no. Supplement 1. S277-96. https://doi.org/10.2337/dc26-S013
  11. LeRoith, Derek, Geert Jan Biessels, Susan S. Braithwaite, et al. 2019. “Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 104 (5): 1520–74. https://doi.org/10.1210/jc.2019-00198.
  12. Samson, Susan L., Priyathama Vellanki, Lawrence Blonde, et al. 2023. “American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm – 2023 Update.” Endocrine Practice 29 (5): 305–40. https://doi.org/10.1016/j.eprac.2023.02.001.

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