The analyzed trends in hyperosmolar hyperglycemic state (HHS) demonstrated increase in hospitalizations, length of stay (LOS), and total hospital charges (THC) between 2008 and 2018, however, reduction in inpatient mortality was evident.

• NIS databases 2008, 2010, 2012, 2014, 2016, and 2018 were used to report rates and trends in hospitalizations, inpatient mortality, total hospital charges, and mean lengths of stay among adult patients hospitalized for HHS.

• A trend towards increasing hospitalizations for T2DM with HHS was observed between 2008 and 2018.

• Over this duration, mean age ranged from 56.9 to 59.1 years old; most of the hospitalizations occurred among men.

• A steady increase in the proportion of Whites and Hispanics with HHS was evident over the decade, and Medicare was the most prevalent insurer overall.

• From 2008 to 2018, a decline in inpatient mortality for HHS occurred from 1.44% to 0.77%, respectively.

• Over this span, both LOS and THC decreased statistically significantly.