Age-Specific Excess Inpatient and ED Use Associated With Diabetes in the U.S.

The study quantified national U.S. excess inpatient admissions and emergency department (ED) visits associated with diabetes across the adult age spectrum using 2019 data sources. - Data sources included the 2019 Behavioral Risk Factor Surveillance System, the National Inpatient Sample, and the Nationwide Emergency Department Sample to estimate events among adults with and without diabetes. - Complications were grouped as traditional diabetes complications (vascular and renal), emerging diabetes-associated conditions, or other co-occurring conditions. - The primary measure was age-standardized absolute risk differences (ARDs) comparing people with versus without diabetes to identify leading causes of excess hospital use by age and setting. - For inpatient admissions, traditional complications dominating excess burden were sepsis, cardiorenal disease, acute kidney failure, myocardial infarction, and stroke; reported ARDs ranged ~296 to 2,623 per 100,000 people with diabetes. - Emerging-condition drivers of excess use included pneumonia, device- and procedure-related complications (ARD range 125–473), and schizoaffective/other mental health disorders among younger adults (ARD range 80–312). - Other co-occurring conditions with notable excess burden across ages included respiratory and fluid/electrolyte disorders (ARD range 100–363); digestive and urinary disorders were more prominent in older adults (ARD range 229–482). - ED visits showed a broadly similar pattern of excess diagnoses but with lower ARDs compared with inpatient admissions (ARD range 101–707). - The authors conclude that diabetes drives substantial, age-specific excess inpatient and ED use and that nontraditional conditions increasingly contribute to this burden rather than only classic vascular and renal complications. - Funding sources included NIDDK grants listed in the article; the article was published online ahead of print in Diabetes Care (2026) with PMID 42611023 and DOI 10.2337/dc26-0861.

Age-specific excess inpatient and ED use associated with diabetes

This study quantified the excess burden of hospital-based care associated with diabetes across adult ages in the United States. The analysis estimated both inpatient admissions and emergency department (ED) visits attributable to diabetes and identified which causes account for the greatest excess use in different age groups. The authors emphasize that the epidemiology of diabetes is shifting—diagnosis is occurring at younger ages and life expectancy is increasing—which may alter patterns of health-care utilization and the conditions driving hospital use.

Data sources and methodological approach

National 2019 datasets were used to derive U.S. estimates of hospital use among adults with and without diabetes. Specifically, the authors combined the 2019 Behavioral Risk Factor Surveillance System with the 2019 National Inpatient Sample and the 2019 Nationwide Emergency Department Sample. These sources provided denominators and event counts required to estimate national rates by age.

The principal analytic metric was the age-standardized absolute risk difference (ARD) in rates of inpatient admissions and ED visits for people with diabetes compared with people without diabetes. ARDs were calculated for cause-specific diagnoses to identify leading contributors to diabetes-related hospital use by age and by care setting. Complications and conditions were grouped into three categories: traditional diabetes complications, conditions emerging as associated with diabetes, and other conditions that commonly co-occur with diabetes.

Definition and categorization of complications

Conditions were categorized as:

Traditional complications: classic vascular and renal complications historically tied to diabetes (for example, myocardial infarction, stroke, and acute kidney injury/failure, cardiorenal disease, and sepsis as a major infectious complication reported in the results).
Emerging diabetes-associated conditions: disorders that are increasingly identified as related to diabetes beyond classic microvascular or macrovascular endpoints (for example, pneumonia, device- and procedure-related complications, and certain mental health disorders in younger adults).
Other co-occurring conditions: a range of diagnoses that frequently co-occur with diabetes and contribute to hospital use (for example, respiratory disorders, fluid and electrolyte disorders, digestive and urinary system disorders).

The article reports ARD ranges for key categories and specific diagnoses rather than single point estimates for all items; those ranges are presented below as reported.

Key inpatient findings: traditional complications

For inpatient admissions, traditional complications accounted for a substantial portion of the excess hospital burden among people with diabetes. The largest contributors in this category were sepsis, cardiorenal disease, acute kidney failure, myocardial infarction, and stroke. Reported ARDs for these traditional complications ranged approximately from 296 to 2,623 additional admissions per 100,000 people with diabetes, indicating substantial absolute excess rates for several classic diabetes-related severe outcomes.

Key inpatient findings: emerging and other conditions

Conditions classified as emerging diabetes-associated diagnoses also contributed meaningfully to excess inpatient use. Notable items in this grouping included pneumonia and device- and procedure-related complications, with reported ARD ranges of about 125 to 473 per 100,000. Mental health diagnoses characterized as schizoaffective or other severe mental health disorders were identified as drivers of excess inpatient admissions specifically among younger adults, with ARDs reported in the range 80 to 312 per 100,000 in those age groups.

The analysis also highlighted several other co-occurring conditions that increased hospital use across age groups. Respiratory disorders and fluid/electrolyte disorders showed ARD ranges approximately 100 to 363 per 100,000 across ages. In older adults, digestive and urinary disorders were more prominent contributors to excess inpatient admissions, with ARD ranges reported roughly 229 to 482 per 100,000.

Emergency department visit patterns and comparisons to inpatient admissions

Cause-specific patterns for ED visits were broadly similar to those seen for inpatient admissions, but absolute risk differences were lower for ED visits. The reported ARD range for ED visits was approximately 101 to 707 per 100,000 people with diabetes, reflecting that while ED use follows similar diagnostic patterns, the magnitude of excess risk is generally smaller in the ED setting versus inpatient admissions.

Implications and conclusions

The authors conclude that diabetes drives substantial, age-specific excess inpatient and ED use in the United States. Importantly, the results indicate an increasing contribution of nontraditional conditions—such as infectious diagnoses, device/procedure complications, and certain mental health disorders—rather than solely classic vascular and renal complications. This shift suggests that health systems and clinicians may need to consider a broader set of conditions when planning prevention and management strategies to reduce hospital-based resource use associated with diabetes across different age groups.

Funding and bibliographic details

The research was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (grants listed in the article). The study was published online ahead of print in Diabetes Care (2026) with PubMed identifier (PMID) 42611023 and DOI 10.2337/dc26-0861. The authors and their institutional affiliations are listed in the source article. Specific numerical details beyond those reported in the abstract or full article text are not provided here.

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