The most common reasons why patients with type 2 diabetes are admitted to hospital with greater frequency than the general population are changing, according to Australian researchers.
They found admission for traditional diabetes complications are now being accompanied by those for a diverse range of lesser-known complications including infections like pneumonia and sepsis, mental health disorders, and gastrointestinal conditions.
“Infections less commonly linked with diabetes and mental health disorders are emerging as leading causes of hospital admissions”
Just four traditional complications – cellulitis, heart failure, urinary tract infections and skin abscesses – were found to be in the top 10 causes of admission in men and women with type 2 diabetes.
The study authors noted that rates of traditional 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 and better preventive care and management.
However, leading causes of death and illness such as cancer, liver disease and mental disorders are emerging among people with diabetes, said the researchers.
In England, for example, classic complications accounted for more than half of hospital admissions in people with diabetes in 2003, but for less than a third in 2018.
They analysed data spanning seven years from around 50% of Australians diagnosed with type 2 diabetes from the Australian Diabetes Registry.
In total, 456,265 individuals with type 2 diabetes registered between 2010 and 2017 were linked with hospital data and compared to over 19 million Australians aged 15 and above.
Modelling was used to identify the leading individual diagnosis-level causes of hospitalisation and to estimate the relative risk of admission compared to the general population. Admissions for type 2 diabetes itself were excluded from the analyses.
Diabetes complications were divided into three categories – traditional complications, complications of procedures related to well-known diabetes complications, and emerging complications.
The latter included liver disease, mental health disorders, various cancers, and infections less commonly associated with diabetes such as respiratory infections and sepsis.
Overall, the analyses found that people with type 2 diabetes were at greater risk of being admitted with most medical conditions compared to the general population.
The leading cause of excess admission in men was cellulitis, followed by the lesser-recognised complications of stress disorders and iron deficiency anaemia.
Diabetes doubled the risk of admission for these conditions compared to the general population, said the study authors.
“The emergence of non-traditional diabetes complications reflects improvements in diabetes management”
In women, iron deficiency anaemia was the leading cause of excess annual admissions, followed by the traditional complications of urinary tract infections and cellulitis.
High rates of excess hospitalisation were also noted for lesser-known complications including depression, gastrointestinal disorders and asthma.
Hospitalisations for asthma were found to be more than twice as likely among women with type 2 diabetes compared to the general population.
Lead author Dr Dee Tomic, from the Baker Heart and Diabetes Institute in Melbourne, noted that traditional complications such as heart failure and cellulitis “remain a substantial burden” for people with type 2 diabetes.
But she said: “Infections less commonly linked with diabetes and mental health disorders are emerging as leading causes of hospital admissions, and have substantial burdens that sometimes exceed the top-ranked well-known complications.
“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,” she said.
She added: “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.”
The study is due to be presented later this month at the European Association for the Study of Diabetes annual meeting in Stockholm.