Non-traditional diabetes complications are on the rise 

Non-traditional diabetes complications are on the rise
©iStock/Fabrizio Rivero Vernengo

Non-traditional diabetes complications such as anaemia, stress disorders, depression, and pneumonia are among the top reasons for type 2 diabetes hospital admissions.  

The reason for people with type 2 diabetes being admitted to hospital are changing. Hospitalisation for traditional diabetes complications is now often accompanied by lesser-known diabetes complications. These include infections (pneumonia and sepsis), mental health disorders, and gastrointestinal conditions.  

People with type 2 diabetes are also admitted with greater frequency for these issues than the general population, this is according to analysis of national data from Australia spanning seven years.  

Traditional diabetes complications are falling

A study which will be presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting has revealed that just four traditional diabetes complications (heart failure, urinary tract infection, skin abscess, and cellulitis) were among the top ten leading causes of type 2 diabetes complications.  

“Although traditional complications such as heart failure and cellulitis remain a substantial burden for people with type 2 diabetes, 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”, said lead author Dr Dee Tomic from the Baker Heart and Diabetes Institute, Melbourne, Australia. 

Rates of traditional type 2 diabetes complications such as heart attack, stroke, and amputations have declined significantly over the last 20 years in high-income countries. This has been driven by improvements in risk factors, for example, blood pressure, smoking, and blood sugar control. The leading causes of death and illness for people with type 2 diabetes are now attributed to other conditions such as cancer and mental disorders.  

In England, traditional diabetes complications accounted for over half of all hospitalisations for people with the condition, and by 2018, they accounted for less than one-third.   

“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. Increasing hospitalisations for mental health disorders as well as infections like sepsis and pneumonia will place an extra burden on healthcare systems and may need to be reflected in changes to diabetes management to better prevent and treat these conditions,” explained Dr Tomic.  

The researchers were eager to examine the reasons for hospitalisation at  diagnostic level. Identifying emerging diabetes complications can help doctors understand the burden of serious illness.  

The researchers analysed data from around 50% of all Australians diagnosed with type 2 diabetes between 2010 and 2017. In total, 456,265 individuals registered on National Diabetes Services Scheme (NDSS) were linked to hospital data and compared to 19 million Australians from the general population.   

People with type 2 diabetes are at higher risk 

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

The leading cause of hospitalisation for men with type 2 diabetes was cellulitis, responsible for 364 excess annual hospitalisations per 100,000 men. Stress disorders accounted for 241 hospitalisations per 100,00 men and anaemia accounted for 228 per 100,000.  

In women, anaemia was the leading cause of hospitalisation with 558 admissions per 100,000 people. This was followed by traditional diabetes complications, urinary tract infections accounted for 332 admissions per 100,000 and cellulitis accounted for 267 admissions per 100,000. 

“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 type 2 diabetes”, said senior author Professor Dianna Magliano, Head of Diabetes and Population Health at Monash University, Melbourne, Australia.  

The unexpected finding of a large burden of anaemia in both men and women with Type 2 diabetes suggests 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.” 


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