Hospitalizations in Patients With Diabetes Largely Driven by Unrelated Conditions

By Brandon May

December 21, 2021

NEW YORK (Reuters Health) - Since 2003, reasons for hospitalizations among people with diabetes in the U.K. has shifted away from diabetes-specific complications and more toward unrelated conditions, a new study shows.

"This study provides insight into the drivers of excess and persistent morbidity in individuals with diabetes more comprehensively and holistically than previous studies," researchers write in The Lancet Diabetes & Endocrinology.

"If we are to replicate the improvements in all-cause mortality in those with diabetes in improvements in hospitalisation and morbidity rates, clinical and targeted preventative efforts should broaden to encompass the diversity of excess hospitalisation risk faced by those with diabetes," Dr. Jonathan Pearson-Stuttard of Imperial College London and colleagues add.

To understand hospitalization trends among patients with diabetes in the U.K., the team performed an epidemiological analysis including more than 309,000 adults with type-1 and -2 diabetes. Data were obtained from the Clinical Practice Research Datalink linked to Hospital Episode Statistics inpatient data from the years 2003 to 2018. Patients with diabetes were matched to patients without diabetes by decade of birth.

Excess hospitalization was calculated using the absolute difference in the hospitalization rate in patients with versus without diabetes.

Hospitalization rates were higher for all causes in patients with diabetes, and varied by sex and time. Overall, in 2003, the leading causes of excess hospitalization were diabetes itself and ischemic heart disease. By 2018, however, the leading causes of excess hospitalization were non-infectious and non-cancerous respiratory conditions, non-diabetes-related cancers, and ischemic heart disease.

Hospitalizations for traditional diabetes complications declined throughout the study period, while hospitalizations for non-diabetes-specific complications increased.

The researchers noted that in 2003, traditional diabetes complications accounted for over 50% of hospitalizations among patients with diabetes, dropping to 30% of hospitalizations in 2018.

The proportions of hospitalizations for respiratory infections among patients with diabetes during the study period rose from 3% to 10% in men and from 4% to 12% in women.

There were similar declines in the non-diabetes population but not to the same extent, Dr. Pearson-Stuttard told Reuters Health by email. "This is partly due to improvements in risk factors over this period such as smoking prevalence and lower sodium intake but also due to earlier diagnosis of the condition and better management of specific cardiometabolic risk factors in part through policy initiatives," he said.

The researcher also suggested that the increased hospitalizations for the broader set of conditions in patients with diabetes could be due to changing phenotypes, which might include a transition away from more traditional vascular risk factors such as high blood pressure and high cholesterol and toward higher rates of obesity and unhealthy dietary patterns.

"We need to understand the etiological mechanism driving the broadening of excess risk in order to identify specific interventions to reduce this risk" in patients with diabetes, he said.

SOURCE: The Lancet Diabetes & Endocrinology, online November 30, 2021.