Hospitalizations for diabetes complications fell, were replaced by other causes
An analysis of excess hospitalizations among people with diabetes in England from 2003 to 2018 found that diabetes caused fewer of their hospital stays, with respiratory disease and cancer becoming more predominant diagnoses.
Diabetes was the top cause of excess hospitalizations for patients with diabetes in 2003, but by 2018, respiratory conditions were responsible for more admissions.
Researchers examined trends in hospitalizations in people with type 1 or 2 diabetes in England from 2003 to 2018. They identified 309,874 adults ages 18 years or older to estimate annual cause-specific hospitalization rates in men and women with diabetes across 17 cause groupings. A 1:1 age- and sex-matched and population of individuals without diabetes was generated to compare cause-specific hospitalization rates. Results were published Nov. 30 in The Lancet Diabetes and Endocrinology.
Traditional diabetes complications accounted for more than 50% of hospitalizations in 2003, but only approximately 30% in 2018. Hospitalizations due to respiratory infections over the same period increased from 3% to 10% in men and from 4% to 12% in women. In 2003, in men with diabetes, diabetes was the leading cause of excess hospitalization, at 158.0 hospitalizations per 10,000 men, followed by ischemic heart disease (138.9 excess hospitalizations per 10,000 men) and noninfectious, noncancerous respiratory conditions (49.5 excess hospitalizations per 10,000 men). By 2018, ischemic heart disease was the leading cause of excess hospitalization (98.7 excess hospitalizations per 10,000 men), followed by non-diabetes-related cancer (89.7 excess hospitalizations per 10,000 men) and respiratory infections (75.8 excess hospitalizations per 10,000 men).
In 2003, in women, the leading causes of excess hospitalization were diabetes (159.4 excess hospitalizations per 10,000 women) and ischemic heart disease (87.9 excess hospitalizations per 10,000 women), followed by kidney infections (64.7 excess hospitalizations per 10,000 women). By 2018, none of these were among the top three causes of excess hospitalization. Instead, noninfectious and noncancerous respiratory conditions (93.5 excess hospitalizations per 10,000 women), respiratory infections (76.3 excess hospitalizations per 10,000 women), and non-diabetes-related cancer (63.6 excess hospitalizations per 10,000 women) were the leading causes.
Preventive and clinical measures should evolve to reflect the diverse set of causes driving persistent excess hospitalizations in those with diabetes, according to the study authors. “If we are to replicate the improvements in all-cause mortality and 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,” they wrote.