The reasons why people with type 2 diabetes are hospitalized change

The most common reasons people with type 2 diabetes (T2DM) are hospitalized with greater frequency than change in the general population, with hospitalization for traditional diabetes complications now associated with admission for a variety of lesser known complications including infection (eg, pneumonia). and sepsis), mental health disorders and gastrointestinal disease, according to an analysis of national data from Australia over seven years.

The findings, presented at this year’s European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden (September 19-23), reveal that four classic complications of diabetes (cellulitis, cellulitis, cellulitis, cellulitis, cellulitis, heart failureAnd the Urinary tract infectionsand skin abscesses) among the top ten causes of hospitalization in men and women with T2DM.

“Although traditional complications such as heart failure and cellulitis remain a significant burden for people with T2DM, infections less closely associated with diabetes and mental health disorders emerge as major causes of hospitalization, with significant burdens sometimes exceeding the highest-ranking complications. ‘,” says lead author Dr. de Tomic of the Baker Heart and Diabetes Institute, Melbourne, Australia.

She adds: “The emergence of atypical diabetes complications reflects improvements in diabetes management and people with diabetes live longer, leaving them vulnerable to a greater range of complications. Increased hospitalization for mental health disorders as well as infections such as sepsis and pneumonia will further burden the health care systems and may need to be reflected in changes in diabetes management to better prevent and treat these conditions.”

Whereas rates of traditional T2DM complications — including heart attack, stroke, and amputation — have decreased dramatically over the past 20 years in many high income countriesdriven by improvements in risk factors (eg, blood pressurecholesterol, smoking, and glycemic control) and improve preventative care and management, which are the leading causes of death and diseases such as cancer, Liver disease Mental disorders are emerging among diabetics. In England, for example, traditional complications accounted for more than half of hospital admissions for people with diabetes in 2003, but less than a third in 2018.

Examining the causes of hospitalization at the population level can help identify emerging complications of diabetes and increase our understanding of the serious disease burden. However, little is known about the causes of the individual diagnosis level for hospitalization among diabetic patients in all diagnostic categories.

To find out more, the researchers analyzed data from about 50% of Australians diagnosed with T2DM from the Australian Diabetes Registry (National Diabetes Services Scheme; NDSS). In total, 456,265 individuals (aged 15 years and over) with type 2 diabetes registered with the NDSS between 2010 and 2017 were linked to hospital data and compared to more than 19 million Australians aged 15 years and over.

Modeling was used to identify major causes of the individual diagnosed level of hospitalization 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. Acceptance of T2DM itself (eg, glucose disturbances such as hypoglycemia) was excluded from the analyses.

Complications of diabetes were divided into three categories - traditional complications which included vascular disease, kidney failure, retinopathy and cataracts, neuropathy, obesity, infections traditionally associated with diabetes (eg, urinary tract), and procedure complications related to complications of diabetes mellitus Known diabetes (eg., amputation). Emerging complications included liver disease, mental health disorders, various types of cancer (eg, gastrointestinal and female reproductive organs), and less common infections associated with diabetes (eg, respiratory tract infections and sepsis). All other diagnoses were classified as ‘uncommonly recognized’ complications.

In general, analyzes have found that people with T2DM have a higher risk of hospitalization with most medical conditions than the general population (exceptions include prostate cancer, aortic aneurysms, and wrist fractures).

The main cause of overhospitalization in men with cellulitis was cellulitis, which was responsible for 364 excess annual admissions per 100,000 men with T2DM, followed by lesser known complications of stress disorders (241 per 100,000) and iron deficiency anemia ( 228 per 100,000) - with diabetes the risk of admission for these conditions is doubled compared to the general population.

In women with T2DM, Iron deficiency anemia The main reason was excess annual admission (558 per 100 000), followed by the classic complications of urinary tract infection (332 per 100 000) and cellulitis (267 per 100 000). High rates of over-hospitalization for less well-known complications including depression (256 per 100,000), gastrointestinal disturbances (237 per 100,000) and asthma (192 per 100,000) - with hospitalization for asthma more than doubled among women with T2DM compared to the general population.

“The much greater risk for most mental health diagnoses in people with diabetes bolsters the evidence for this mental health disorders as an emerging complication of T2DM,” says Senior Professor Diana Magliano, Head of the Department of Diabetes and Population Health at Monash University, Melbourne, Australia. The unexpected findings of the high burden of anemia in men and women with T2DM suggest the possibility of a biological relationship between diabetes and iron deficiency. To consider these and other new findings in more detail, we must perform further analyzes as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and management strategies.”

The authors acknowledge that their findings show associations based on observation rather than cause and effect. They also noted some limitations, including that the study included people from one high-income country with a predominantly white Caucasian population, so the results cannot be generalized to low- and middle-income countries. In addition, they could not exclude people with diabetes from the general population, so the strength of the associations may be underestimated compared to the analysis of people with diabetes versus people without it. diabetic.