For Patients With Diabetes, Review Finds CVD to Be Leading Cause of Hospital Admissions

Among people with diabetes, cardiovascular disease (CVD) was the leading cause of hospital admissions, with ischemic and coronary heart disease being the 2 major CVD subtypes contributing to admissions among this population.

These findings are based on a review of 42 studies—10 of which were conducted in the United States—published between 1980 and 2022 that reported the distribution of hospital admissions based on broad categories among people with diabetes, type 1 (T1D) and 2. The review was published in Diabetic Medicine.

Of the 25 studies encompassing both diabetes in general and type 2 diabetes specifically, CVD was the predominant reason for hospital admission in 19 (76%) of the studies. These 19 studies also provided further details on CVD admissions, and of this subset, ischemic or coronary heart disease took the lead as the primary subtype in 11 of these papers, while heart failure was listed as a leading cause in 8 papers.

Additionally, when examining hospital admissions over time, the review authors found that CVD was the leading cause of admission in 9 of 10 studies published between 1980 and 2014 and in 10 of 15 studies published from 2015 to 2022.

Other common causes for hospital admissions included infections and renal, endocrine, nutritional, metabolic, and immunity-related disorders.

Hospital sign | Image Credit: Spiroview Inc. – stock.adobe.com

According to the review, infection was the leading cause of admissions in 6 studies and a second leading cause in 3 studies. These infections primarily included respiratory tract infections, followed by skin and bone infections.

“It has been long established that those with diabetes have an excess risk for infection because high blood glucose levels cause defects in the adaptive and innate immunity pathways, so that microorganisms easily grow and multiply," the review authors noted. “Among people with diabetes, infection can be more severe than among those without.”

Significantly, 22 studies reported admission for renal conditions in a consistent manner, as renal conditions were the first, second, and third leading cause of admission in 1, 4, and 4 studies, respectively.

“There are multiple factors that affect the normal physiology of the renal system in persons with diabetes, hyperglycemia and hypertension being 2 key factors causing kidney diseases,” the authors noted. “Regular screening for kidney disease in people with diabetes will detect kidney disease at an early stage and early interventions may delay the progression to end-stage kidney disease.”

Endocrine, nutritional, metabolic, and immunity disorders ranked as the second most prevalent cause of hospitalization in 6 studies. Cancer emerged as the second leading reason for admission in 3 studies and held the third position in 4 other studies. Notably, cancer of the digestive system was identified as the primary cause for cancer-related admissions among individuals with diabetes.

“Both type 2 diabetes and cancer share a number of risk factors such as inadequate fruit and vegetable intake, high alcohol intake, physical inactivity, smoking cigarettes, poor dietary intake, obesity, and aging,” the review authors wrote. “The number of people living with cancer and diabetes has increased, which calls for the implementation of effective cancer prevention activities in people with diabetes to decrease morbidity and mortality associated with them.”

Diseases related to the digestive system were the second, third, and fourth most common cause of admission in 1, 2, and 3 studies, respectively. Additionally, injury and poisoning ranked as the third, fourth, and fifth leading causes of admission in 1, 1, and 4 studies, respectively.

Notably, individuals with T1D most frequently experienced hospitalizations due to acute complications associated with diabetes. Of 7 papers presenting data on hospitalization among individuals with T1D, these acute complications were the primary reason for admission in 3 of the studies. Infections were a leading cause in 2 studies, and digestive disorders were a leading cause in 1 study. Additionally, 1 study identified cancer as the second most common reason for admission for patients with T1D.

The review authors also noted that hospitalizations resulting from chronic complications of diabetes were infrequent in individuals with T1D, likely due to the relatively younger age of the populations with T1D in the studies included in the review.

Study limitations include the nonuniform reporting of disease categories, leading to uncertainty in ranking hospital admission categories, and dissimilar inclusion criteria among studies raising caution in interpreting results. The authors also noted the lack of data from lower-income countries, absence of sociodemographic and clinical variables in hospitalization patterns, and changes in diabetes diagnosis criteria and management over the 42-year analysis period as additional limitations.

Reference

Feleke BE, Sacre J, Tomic D, Huynh Q, Shaw JE, Magliano DJ. Hospital admissions among people with diabetes: a systematic review. Diabet Med. 2023;e15236. doi:10.1111/dme.15236