Rates of traditional type 2 diabetes complications — heart attack, stroke and amputations — have fallen substantially over the past 20 years in many high-income countries. Cellulitis, stress disorders and iron deficiency anaemia are now among the leading cause of excess hospitalisation for people with diabetes.

The most common reasons why people with type 2 diabetes are admitted to hospital with greater frequency than the general population are changing.

Hospitalisation for traditional diabetes complications are now being accompanied by admissions for a diverse range of lesser-known complications including infections (ie, pneumonia, sepsis), mental health challenges, and gastrointestinal conditions, according to an analysis of national data from Australia spanning seven years.

The data reveal that just four traditional diabetes complications (cellulitis, heart failure, urinary tract infections, and skin abscesses) were ranked in the top 10 leading causes of hospitalisation in men and women living with type 2 diabetes.

The findings will be presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19–23 Sept).

Improvements in diabetes management

“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,” says lead author Dr Dee Tomic from the Baker Heart and Diabetes Institute, Melbourne.

“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,” Dr Tomic said. 

Rates of traditional type 2 diabetes complications — heart attack, stroke and amputations — have fallen substantially over the past 20 years in many high-income countries.

The decrease is being driven by improvements in risk factors (eg, blood pressure, cholesterol, smoking, and blood glucose managementl) and better preventive care and management.

Additionally, leading causes of death and illness such as cancer, liver disease and mental health issues are emerging among people with diabetes. In England, for example, classic complications accounted for more than half of hospitalisations in people with diabetes in 2003, but for less than a third in 2018.

To find out more about the individual-diagnosis level reasons for hospitalisation, researchers analysed data from around 50 per cent of Australians diagnosed with type 2 diabetes from the Australian Diabetes Registry (the National Diabetes Services Scheme; NDSS).

In total, 456,265 individuals (aged 15 years and older) with type 2 diabetes registered on the NDSS between 2010 and 2017 were linked with hospital data and compared to over 19 million Australians aged 15 and above.

Researchers found that people with type 2 diabetes are at greater risk of being hospitalised with most medical conditions compared to the general population (exceptions include prostate cancer, aortic aneurysm and wrist fractures).

Cellulitis, stress disorders and iron deficiency anaemia hospitalisations

The leading cause of excess hospitalisations in men living with type 2 diabetes was cellulitis, followed by the lesser-recognised complications of stress disorders and iron deficiency anaemia — with diabetes doubling the risk of admission for these conditions compared to the general population.

In women living with type 2 diabetes, 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 — with hospitalisations for asthma more than twice as likely amongst women with type 2 diabetes compared to the general population.