The Most Common Complications – They’re Not What You Think 

The top 10 reasons why men and women with Type-2 Diabetes end up in the hospital.

An analysis of national data from Australia over the course of seven years found that the reasons why people with type 2 diabetes (T2DM) are admitted to the hospital at a higher rate than the general population are shifting, with hospitalization for traditional diabetes complications now joined by admissions for a diverse range of lesser-known complications like infections (ie. pneumonia, sepsis), mental health disorders, and gastrointestinal conditions.

The results, which will be presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden, from September 19–23, show that only four traditional diabetes complications—cellulitis, heart failure, urinary tract infections, and skin abscesses—made the list of the top 10 reasons why men and women with T2DM end up in the hospital.

Diabetes management advances

“The emergence of non-traditional diabetes complications,” according to Dr. Dee Tomic, the study’s lead author, “reflects improvements in diabetes management and people with diabetes living longer, making them susceptible to a broader range of complications.”  

In order to properly prevent and treat these problems, according to the author, the healthcare system will be under additional strain from rising hospitalizations for mental health issues as well as infections like sepsis and pneumonia.

While rates of traditional T2DM complications, such as heart attack, stroke, and amputations, have significantly decreased over the past 20 years in many high-income countries due to improvements in risk factors (such as blood pressure, cholesterol, smoking, and blood sugar control), leading causes of death and illness, such as cancer, liver disease, and mental disorders are emerging among those with diabetes. Classic complications, for instance, accounted for more than half of hospitalizations for diabetics in England in 2003 but fewer than a third in 2018.

Researchers examined data from the Australian Diabetes Registry, which included information on nearly 50% of Australians with T2DM, to learn more about the reasons for hospitalization at the individual-diagnosis level (the National Diabetes Services Scheme; NDSS).

Over 19 million Australians aged 15 and over were compared to the 456,265 people (aged 15 years and older) with type 2 diabetes who enrolled on the NDSS between 2010 and 2017.

According to research, patients with T2DM are more likely than the general population to require hospitalization for the majority of medical illnesses (exceptions include prostate cancer, aortic aneurysm and wrist fractures).

Stress problems, cellulitis, and iron deficient anemia
Cellulitis was the leading cause of excess hospitalizations in men with T2DM, accounting for 364 extra annual admissions per 100,000 men with T2DM. Stress disorders (241 per 100,000) and iron deficiency anemia (228 per 100,000) were the next-most common complications, with diabetes doubling the risk of admission for these conditions compared to the general population.

Iron deficiency anemia (558 per 100,000) and the conventional complications of urinary tract infections (332 per 100,000) and cellulitis were the two main causes of extra yearly hospitalizations in women with T2DM (267 per 100,000). Asthma hospitalizations were more than twice as prevalent among women with T2DM than in the general population, and rates of excess hospitalization for less well-known complications such as depression (256 per 100,000), gastrointestinal disorders (237 per 100,000), and asthma (192 per 100,000) were also high.

As explained by Dianna Magliano, Head of Diabetes and Population Health at Monash University, Melbourne, Australia, “the much greater risk for most mental health diagnoses in the diabetes population reinforces the evidence for mental health disorders as an emerging complication of T2DM.”

“The unexpected finding of a large burden of anaemia in both men and women with T2DM suggests,” according to the experts, “the possibility of a biological link between diabetes and iron deficiency. 

“To look at this and other novel findings in more detail, we must conduct further analyses as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and management strategies.”

However, the scientists did note that their results only demonstrate correlations and not causations. They also point out that the findings cannot be generalized to low and middle-income countries because they only included persons from one high-income country with a largely white Caucasian population. Also, they couldn’t keep people with diabetes out of the general population, so the associations might not be as strong as they would be if they had looked at people with and without diabetes separately.

Image Credit: Getty

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