Australian researchers have found that anaemia, mental health disorders and gastrointestinal disorders are leading reasons for excess hospitalisation among type 2 diabetics, compared to the general population. The study ‘Reasons for hospitalisation in Australians with type 2 diabetes compared to the general population, 2010-2017’, by researchers from the Baker Heart and Diabetes Institute (Melbourne, Australia) was published in Diabetes Research and Clinical Practice, and is the first of its kind to delve into the specifics of hospitalisations for people living with type 2 diabetes in the country.
"We've never seen this result described before," explained Baker Heart and Diabetes Institute lead researcher, Professor Dianna Magliano, Head of the Diabetes and Population Health Lab. "The burden of anaemia in those with type 2 diabetes was one of the most surprising observations. While it's known that diabetes can contribute to anaemia through reduced iron absorption, gastrointestinal bleeding and through complications that cause anaemia, it was unexpected to see the association between diabetes and iron deficiency anaemia feature so significantly as a complication. What our study has shown is that people with type 2 diabetes are at greater risk of hospitalisation for most medical conditions compared to the general population, including conditions not commonly associated with diabetes. These are important findings that demonstrate the need to revise diabetes management to account for the changing spread of complications."
Data from 456,265 people with type 2 diabetes registered in the National Diabetes Services Scheme between 2010 and 2017 were used for the study. The researchers reported that Australians with diabetes were at increased risk of hospitalisation for most conditions. In addition to traditional complications including heart failure, other conditions such as mental health disorders and anaemias were major causes for excess hospitalisation, compared to the general population.
The leading cause of excess hospitalisation in women with diabetes was iron deficiency anaemia, responsible for 558 excess annual hospitalisations per 100,000 women with diabetes. In men, the leading cause was cellulitis, responsible for 364 excess annual hospitalisations per 100,000.
"Because we now have better diabetes management, the proportion of those presenting to hospital with cardiovascular disease and kidney disease is reducing," added Magliano. "But we are now seeing a diversification of diabetes complications. This is an important clinical finding as it means we may have to reassess diabetes management to include treatment and prevention of these other rising conditions."
Other well-known complications that were responsible for large numbers of excess hospitalizations included heart failure, heart attack and angina. However, mental health disorders, including stress disorders, depression, and schizophrenia, had levels of hospitalisations that in some cases exceeded the top-ranked traditional diabetes complications.
"Recognizing that this is an issue, and working out what is causing the problem, will help us to identify and treat iron deficiency before it gets to a stage of needing a hospital admission," said Professor Jonathan Shaw, head of Clinical and Population Health at the Baker Institute, and a co-author of this report. "In men, stress disorders accounted for the highest number of excess admissions of all diagnoses, with the exception of cellulitis. This reinforces the evidence that mental health disorders are also an emerging complication of diabetes."
Asthma was also associated with a high number of hospitalisations in women. While this is a novel finding, there is evidence suggesting a link between obesity, diabetes, and asthma, which is thought to be related to high cholesterol, high insulin levels and physical inactivity.
Magliano's team will conduct further studies using other datasets to validate the recent findings and explore the mechanisms underpinning these findings: "Our findings suggest the possibility of a biological link between type 2 diabetes and iron deficiency anaemia, but further research is required to confirm this," she said.