Hospitalisation causes for people with type 2 diabetes changing

The most common reasons why people with type 2 diabetes (T2DM) are admitted to hospital with greater frequency than the general population are changing, with hospitalisation for traditional diabetes complications now being accompanied by admissions for a diverse range of lesser-known complications including infections (ie, pneumonia, sepsis), mental health disorders, and gastrointestinal conditions, according to an analysis of national data from Australia spanning seven years.

The findings being presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19–23 Sept), reveal that just four traditional diabetes complications (cellulitis, heart failure, urinary tract infections, and skin abscesses) were ranked in the top 10 leading causes of hospitalisation in men and women with T2DM.

Improvements in diabetes management

Lead author Dr Dee Tomic from the Baker Heart and Diabetes Institute, Melbourne, Australia said, “The emergence of non-traditional diabetes complications reflects improvements in diabetes management and people with diabetes living longer, making them susceptible to a broader range of complications. Increasing hospitalisations for mental health disorders as well as infections like sepsis and pneumonia will place extra burden on healthcare systems and may need to be reflected in changes to diabetes management to better prevent and treat these conditions.” 

While rates of traditional T2DM complications — including heart attack, stroke and amputations — have fallen substantially over the past 20 years in many high-income countries, driven by improvements in risk factors (eg, blood pressure, cholesterol, smoking, and blood sugar control) and better preventive care and management, leading causes of death and illness such as cancer, liver disease and mental disorders are emerging among people with diabetes¹. In England, for example, classic complications accounted for more than half of hospitalisations in people with diabetes in 2003, but for less than a third in 2018².

To find out more about the individual-diagnosis level reasons for hospitalisation, researchers analysed data from around 50% of Australians diagnosed with T2DM from the Australian Diabetes Registry (the National Diabetes Services Scheme; NDSS).

In total, 456,265 individuals (aged 15 years and older) with type 2 diabetes registered on the NDSS between 2010 and 2017 were linked with hospital data and compared to over 19 million Australians aged 15 and above.

Researchers found that people with T2DM are at greater risk of being hospitalised with most medical conditions compared to the general population (exceptions include prostate cancer, aortic aneurysm and wrist fractures).

Cellulitis, stress disorders and iron deficiency anaemia

The leading cause of excess hospitalisations in men with T2DM was cellulitis, responsible for 364 excess annual hospitalisations per 100,000 men with T2DM, followed by the lesser-recognised complications of stress disorders (241 per 100,000) and iron deficiency anaemia (228 per 100,000) — with diabetes doubling the risk of admission for these conditions compared to the general population.

In women with T2DM, iron deficiency anaemia was the leading cause of excess annual admissions (558 per 100,000), followed by the traditional complications of urinary tract infections (332 per 100,000) and cellulitis (267 per 100,000). High rates of excess hospitalisation were also noted for lesser-known complications including depression (256 per 100,000), gastrointestinal disorders (237 per 100,000) and asthma (192 per 100,000) — with hospitalisations for asthma more than twice as likely amongst women with T2DM compared to the general population.

“The much greater risk for most mental health diagnoses in the diabetes population reinforces the evidence for mental health disorders as an emerging complication of T2DM”, says senior author Professor Dianna Magliano, Head of Diabetes and Population Health at Monash University, Melbourne, Australia.

“The unexpected finding of a large burden of anaemia in both men and women with T2DM suggests the possibility of a biological link between diabetes and iron deficiency. To look at this and other novel findings in more detail, we must conduct further analyses as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and management strategies.”

The authors acknowledged that their findings show observational associations rather than cause and effect. They also note some limitations, including that the study included people from one high-income country with a predominantly white Caucasian population, so the findings cannot be generalised to low- and middle-income countries. Additionally, they were unable to exclude people with diabetes from the general population, so the strength of the associations might be reduced compared to an analysis of people with versus without diabetes.

Image credit: iStockphoto.com/Sneksy