medwireNews: Hospitalization rates for traditional diabetes complications such as vascular disease have fallen since 2003 and been replaced by an increase in hospital admittance for other conditions nonspecific to diabetes, study findings indicate.
“Changes in the composition of excess risk and hospitalisation burden in those with diabetes means that preventative and clinical measures should evolve to reflect the diverse set of causes that are driving persistent excess hospitalisation in those with diabetes,” write Jonathan Pearson-Stuttard (Imperial College London, UK) and co-authors in The Lancet Diabetes & Endocrinology.
Pearson-Stuttard and team analyzed data for 309,874 individuals with diabetes (type 1 or 2) in England between 2003 and 2018 and a similar number of sex-matched controls without diabetes.
They found that, although there was a decreasing trend for hospitalization overall, the people with diabetes had higher hospitalization rates across 17 cause-specific groups than those without diabetes throughout the 16-year study period, and incidence varied by sex and time.
In 2003, diabetes itself was the leading cause of excess hospitalization in both men and women, relative to people with no diabetes, with 158.0 and 159.4 excess hospitalizations per 10,000 men and women, respectively. This was followed by ischemic heart disease, at excess rates of 138.9 and 87.9 hospitalizations per 10,000 men and women, respectively.
In 2018, ischemic heart disease, nondiabetes-related cancers, and respiratory infections were the leading causes of excess hospitalizations in men, at rates of 98.7, 89.7, and 75.8 excess cases per 10,000, respectively. For women, the top three causes of excess hospitalization were noninfectious and noncancerous respiratory conditions, respiratory infections, and nondiabetes-related cancers, at rates of 93.5, 76.3, and 63.6 excess hospitalizations per 10,000, respectively.
The researchers say that the differing temporal trends they observed “contributed to a diversification in causes of hospitalisation over the 16-year period, away from diabetes-specific complications.”
For example, between 2003 and 2018, the proportion of hospitalizations due to vascular diseases declined from 31% to 20% in men and from 28% to 16% in women, while the collective rates of hospitalizations due to diabetes-specific complications (vascular, diabetes, and amputations) fell from 58% to 38% in men and from 49% to 28% in women.
Conversely, hospitalizations due to respiratory infections increased from 4% to 11% in men and from 5% to 12% in women, and hospitalizations due to sepsis increased from 1% to 6% in both men and women, with infections having the largest proportional increases overall.
Pearson-Stuttard and colleagues also note that unlike other traditional diabetes complications, hospitalization for hyperglycemic crises increased by 40% in men and by 26% in women during the course of the study.
In an accompanying commentary, Srikanth Bellary, from Aston University in Birmingham, UK, says: “The diversification of the causes of hospitalisations seen in this study provide important insights into the changing character of diabetes complications.”
He writes: “The great rise in non-traditional diabetes complications observed in this study is a big revelation and an indication of challenges to come. Increasing hospitalisations for sepsis, respiratory illnesses, and cancers, not commonly associated with diabetes, is a major concern.”
Bellary says that the increase in nontraditional diabetes complications will place extra burden on healthcare systems and that “[t]ackling this challenge will require a concerted effort from educators, health care professionals, and policy makers.”
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Lancet Diabetes Endocrinol 2021; doi:10.1016/ S2213-8587(21)00288-6
Lancet Diabetes Endocrinol 2021; doi:10.1016/ S2213-8587(21)00313-2