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Hospitalization Rates for Patients with Prediabetes and Diabetes Increasing

Age-adjusted hospitalization rates for acute MI and stroke on the rise as more people are diagnosed with diabetes and prediabetes.

During the 72nd ADA Scientific Sessions in 2012, experts presented that from 1988 to 2009, the age-adjusted hospitalization rate for acute MI per 1,000 patients with diabetes declined from 24.7 to 7.7 (average annual percentage change: –5.3% per year). During the same period, the age-adjusted hospitalization rate for stroke decreased from 18.9 to 9.2 per 1,000 patients with diabetes (average annual percentage change: –3.9% per year).

Back in 2012, the researchers also found significant declines in age-specific rates and age-adjusted rates by sex and race. Both men and women had steeper declines in the later part of the study period, with a decline beginning earlier for men than for women. For both acute MI and stroke hospitalization, the decline among men began in 1995 and the decline among women began in 2001. A similar trend was observed among black and white patients, with white patients experiencing a steeper decline in hospitalizations earlier than black patients.

Compared with patients without diabetes, rates of decline were greater for patients with diabetes from 1988 to 2009 (acute MI: –6.1% vs. –2.3%; stroke: –4% vs. –0.6%).

These findings were consistent with reports showing declines in CVD death rates in the diabetic population.  At that time, the researchers said the declines observed in this study may be due to a reduction in the prevalence of risk factors and new or more aggressive treatment of CV risk factors.

It  was good news in 2012 that things seemed to be getting better, but today that is just not the case.  With more and more people being diagnosed with diabetes and prediabetes, all those rates are now going in the opposite direction.

Adults with diagnosed diabetes and an A1C level of at least 7% were 3.5 times more likely to be hospitalized than those without a history of diagnosed diabetes and those with an A1C of 5.7% or less, while those with prediabetes were 1.3 times more likely to be hospitalized than those with an HbA1c of 5.7% or less, according to a study in Diabetes Care. Researchers analyzed data from 13,522 adults with and without diagnosed diabetes and prediabetes at baseline and a mean age of 57, and found those with diagnosed diabetes had significantly higher hospitalization rates for cardiovascular, endocrine, genitourinary, neoplasm and respiratory causes than those without diagnosed diabetes.

The object of this new study was to examine the magnitude and types of hospitalizations among persons with prediabetes, undiagnosed diabetes, and diagnosed diabetes.

This study included 13,522 participants in the Atherosclerosis Risk in Communities study (mean age 57 years, 56% female, 24% black, 18% prediabetes, 4% undiagnosed diabetes, 9% diagnosed diabetes) with follow-up between 1990–2011 for hospitalizations.

Participants were categorized by diabetes/HbA1C status: without diagnosed diabetes, HbA1C <5.7% (reference); prediabetes, 5.7 to <6.5%; undiagnosed diabetes, ≥6.5%; and diagnosed diabetes, <7.0 and ≥7.0%.

The results showed that the demographic adjusted rates per 1,000 person-years of all-cause hospitalizations were higher with increasing diabetes/HbA1C category (Ptrend < 0.001). Persons with diagnosed diabetes and HbA1C ≥7.0% had the highest rates of hospitalization (3.1 times higher than those without a history of diagnosed diabetes, HbA1C <5.7%, and 1.5 times higher than those with diagnosed diabetes, HbA1C <7.0%, P < 0.001 for both comparisons). Persons with undiagnosed diabetes had 1.6 times higher rates of hospitalization and those with prediabetes had 1.3 times higher rates of hospitalization than those without diabetes and HbA1C <5.7% (P < 0.001 for both comparisons). Rates of hospitalization by diabetes/HbA1C category were different by race (Pinteraction = 0.011) and by sex (Pinteraction = 0.020). There were significantly excess rates of hospitalizations due to cardiovascular, endocrine, respiratory, gastrointestinal, iatrogenic/injury, neoplasm, genitourinary, neurologic, and infection causes among those with diagnosed diabetes compared with those without a history of diagnosed diabetes (all P < 0.05).

Middle-aged adults with prediabetes and diabetes — whether diagnosed or undiagnosed — had significantly higher hospitalization rates over 20 years compared with those without a history of diabetes, according to recent findings.

In an analysis of adults participating in the ongoing Atherosclerosis Risk in Communities (ARIC) study, researchers also found that patients with diabetes and a higher HbA1c had higher rates of hospitalization vs. those with a lower HbA1c.

From the results it was concluded that people with diagnosed diabetes, undiagnosed diabetes, and prediabetes are at a significantly elevated risk of hospitalization compared with those without diabetes. Substantial excess rates of hospitalizations in people with diagnosed diabetes were for endocrine, infection, and iatrogenic/injury causes, which may be preventable with improved diabetes care.

Practice Pearls:

  • Middle-aged adults with prediabetes and diabetes — whether diagnosed or undiagnosed — had significantly higher hospitalization rates over 20 years.
  • People with diagnosed diabetes, undiagnosed diabetes, and prediabetes are at a significantly elevated risk of hospitalization.
  • Increased efforts are needed to reduce the burden of preventable hospitalization among persons with diabetes.

 

“Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study.” Diabetes Care. March 7, 2016