Non-traditional complications , such as anemia, stress disorders, depression, and pneumonia, are among the main reasons why people with type 2 diabetes are admitted to the hospital more frequently compared to the general population.
An Australian study following 456,000 people with type 2 diabetes for 7 years reveals that only four traditional complications of diabetes now feature in the top ten causes of excess hospital admissions. The authors call for diabetes management strategies to be reviewed to take into account the substantial burden of lesser-known diabetic complications.
The most common reasons why people with type 2 diabetes (T2DM) are admitted to hospital more frequently than the general population are changing, and hospitalization for traditional diabetes complications is now accompanied by admissions for a wide range of complications. less known, including infections (pneumonia, sepsis), mental health disorders and gastrointestinal conditions, according to an analysis of Australian national data spanning seven years.
Findings presented at this year’s European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden (September 19-23), reveal that only four traditional complications of diabetes (cellulitis, heart failure, heart disease, urinary tract infections, and skin abscesses) were ranked among the top ten causes of hospitalization in men and women with T2DM.
“Although traditional complications, such as heart failure and cellulitis, remain a major burden for people with T2DM, infections less commonly related to diabetes and mental health disorders are emerging as the leading causes of hospital admissions, and They have significant burdens that sometimes exceed well-classified ones, says lead author Dr. Dee Tomic, of the Baker Heart and Diabetes Institute , Melbourne, Australia.
She adds: “The emergence of non-traditional diabetic complications reflects improvements in diabetes control and that people with diabetes are living longer, making them susceptible to a wider range of complications. Increased hospitalizations for mental health disorders, as well as infections such as sepsis and pneumonia, will place additional burden on healthcare systems and may need to be reflected in changes in diabetes management to prevent and treat these conditions better.”
While rates of traditional complications of T2DM, including heart attacks, strokes, and amputations, have decreased substantially over the past 20 years in many high-income countries, driven by improvements in risk factors (e.g., blood pressure cholesterol, smoking and blood glucose control) and better preventive care and management, leading causes of death and diseases such as cancer, liver disease and mental disorders are emerging among people with diabetes. In England, for example, classic complications accounted for more than half of hospitalizations for people with diabetes in 2003, but less than a third in 2018.
Examining the reasons for hospitalization at the population level may help identify emerging complications of diabetes and increase our understanding of the burden of severe disease. However, little is known about the reasons for hospitalization at the individual diagnosis level among people with diabetes across all diagnostic categories.
To find out more, researchers analyzed data from around 50% of Australians diagnosed with T2DM from the Australian Diabetes Registry (the National Diabetes Services Scheme; NDSS). In total, 456,265 people (aged 15 years and older) with type 2 diabetes registered in the NDSS between 2010 and 2017 were linked to hospital data and compared to more than 19 million Australians aged 15 years and older.
Models were used to identify the leading individual causes of hospitalization at the diagnosis level among people with T2DM and to estimate the relative risk of hospitalization compared to the general population, after adjusting for the effects of age and calendar year. Admissions for T2DM per se (e.g., glucose disturbances such as hypoglycemia) were excluded from the analyses.
Complications of diabetes were divided into three categories : traditional complications including vascular disease, renal failure, retinopathy and cataracts, neuropathy, obesity, infections traditionally related to diabetes (e.g., urinary tract), and procedural complications related to complications. known causes of diabetes (e.g., amputation). Emergent complications included liver disease, mental health disorders, various types of cancer (e.g., gastrointestinal, female sexual organs), and infections less commonly associated with diabetes (e.g., respiratory infections, sepsis). All other diagnoses were classified as “not commonly recognized” complications .
Overall, analyzes found that people with T2DM have a higher risk of being hospitalized for most medical conditions compared to the general population (exceptions include prostate cancer, aortic aneurysm, and wrist fractures).
The leading cause of excess hospitalizations in men with T2DM was cellulitis , responsible for 364 excess annual hospitalizations per 100,000 men with T2DM, followed by the less recognized complications of stress disorders (241 per 100,000) and anemia. iron deficiency (228 per 100,000)—with diabetes doubling the risk of admission for these conditions compared with the general population (see table in notes to editors).
In women with T2DM, iron deficiency anemia 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 hospitalization were also observed for lesser-known complications, such as depression (256 per 100,000), gastrointestinal disorders (237 per 100,000), and asthma (192 per 100,000), with hospitalizations for asthma more than twice as likely among women with DM2 compared to the general population.
“The much higher risk of most mental health diagnoses in the diabetes population reinforces the evidence for mental health disorders as an emerging complication of T2DM,” says lead author Professor Dianna Magliano, Head of Diabetes. and population health at Monash University, Melbourne, Australia. “The unexpected finding of a high burden of anemia in both men and women with T2DM suggests the possibility of a biological link between diabetes and iron deficiency. To analyze this and other novel findings in more detail, we need to conduct more analyzes as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and control strategies.”
The authors acknowledge that their findings show observational associations rather than cause and effect. They also point out some limitations, including that the study included people from a high-income country with a predominantly white Caucasian population, so the findings cannot be generalized 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 could be reduced compared to an analysis of people with diabetes versus without diabetes.
