What Are the Most Common Reasons for Hospital Admissions for Patients With Diabetes?

Patients with diabetes are admitted to the hospital with greater frequency and cost for soft tissue and bone infections, urinary tract infections, stroke, and electrolyte disorders than those without the disease, a new study showed.

The findings prompted researchers to call for strategies to better treat those conditions in these patients.

In a study published by CMAJ Open, researchers reviewed data from 150,499 hospital admissions between 2010 and 2015 at 7 Toronto hospitals; more than one-quarter of patients had diabetes.

Compared with patients without diabetes, hospital admissions because of soft tissue and bone infections were more frequent (2.5% v. 1.9%; prevalence ratio [PR], 1.28; 95% CI, 1.19-1.37) and costly in Canadian dollars ($8794 v. $5845; cost ratio [CR] 1.50; 95% CI, 1.37-1.65) among patients with diabetes.

That set of infections was followed by urinary tract infections (PR, 1.16; 95% CI, 1.11–1.22; CR, 1.23; 95% CI, 1.17-1.29); stroke (PR, 1.13; 95% CI, 1.07–1.19; CR, 1.19; 95% CI, 1.14–1.25); and electrolyte disorders (PR, 1.11; 95% CI, 1.03-1.20; CR, 1.20; 95% CI, 1.08–1.34).

Nearly 1 in 10 individuals in the United States and Canada are diagnosed with diabetes, a figure that is projected to increase to 1 in 5 by 2050, the study noted. Diabetes cost Canada $2.18 billion (US$ 1.8 billion) in 2008 in hospital admissions, physician care, and medication, with an additional cost from new cases estimated at $15.36 billion in 2022. One-fourth of all US health care expenditures in 2017 were incurred by those with diabetes.

Soft tissue and bone infections have not received the attention they should, the authors said. For decades, lower-extremity amputations for diabetes patients had been falling, but a 2017 meta-analysis showed amputations beginning to rise again. The authors recommended preventive measures including regular foot examinations, debridement, mechanical offloading devices, and visits to podiatrists.

Regarding urinary tract infections, the authors called for a focus on asymptomatic bacteriuria. There also needs to be better understanding of the safety of sodium-glucose co-transporter-2 inhibitors, which are used in diabetes treatment, on urinary tract infections.

Individuals with diabetes are twice as likely to have a stroke than those without the disease. Adoption in recent years of strategies to treat cardiac conditions have reduced rates of stroke overall significantly, but admissions remain more common among diabetes patients, the researchers said.

In addition, the study found acute renal failure (PR, 2.02; 95% CI, 1.87-2.17); heart failure (PR, 1.88; 95% CI, 1.80-1.96); soft tissue and bone infections (PR, 1.28; 95% CI, 1.19-1.37); sepsis (PR, 1.22; 95% CI, 1.14-1.31; urinary tract infections (PR, 1.16; 95% CI, 1.11-1.22); delirium (PR, 1.15; 95% CI 1.08-1.23); stroke (PR, 1.13; 95% CI, 1.07-1.19); and electrolyte disorders (PR, 1.11; 95% CI, 1.03-1.20) were the more common reasons for hospital admission among patients with diabetes compared with those without.

However, acute renal failure, heart failure, sepsis, and delirium were not associated with a higher cost.

For the most common causes of admission in the diabetes population, the median costs were $12,916 for delirium, $10,722 for sepsis, $8794 for soft tissue and bone infections, $8270 for stroke, $6821 for heart failure, $6301 for acute renal failure, $6278 for chronic obstructive pulmonary disease, $6183 for pneumonia, $5442 for urinary tract infection and $4422 for electrolyte disorders.

Overall, acute inpatient hospital admissions account for more than half of all healthcare costs related to diabetes. Diabetes itself a rarely a reason for admission; comorbid conditions are the drivers of admissions.

Reference

Choi J, Booth G, Hung, HY. Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study. CMAJ Open. 2021;9(2): E406-512. doi:10.9778/cmajo.20190213