Diabetes Hospitalizations Aren’t Just About Heart and Kidney Disease Anymore

Hospitalizations among people with diabetes involve much more than heart attacks, strokes, and kidney failure. U.S. research shows that infections, respiratory conditions, mental health disorders, and fluid imbalances also contribute substantially to emergency visits and inpatient admissions. Moreover, the leading reasons for hospital care differ across age groups. These findings suggest that preventing diabetes-related complications requires a broader approach than traditional cardiovascular and kidney disease management.

Table of Contents

1. New Research Reveals a Broader Hospitalization Burden
2. Infections, Respiratory Illness, and Other Emerging Risks
3. Why Diabetes-Related Hospital Visits Differ by Age
4. Rethinking Prevention and Diabetes Care
5. Conclusion
6. Frequently Asked Questions

New Research Reveals a Broader Hospitalization Burden

A 2026 study published in Diabetes Care examined the excess burden of hospital admissions and emergency department visits among U.S. adults with diabetes. Researchers analyzed nationally representative data from the 2019 Behavioral Risk Factor Surveillance System, National Inpatient Sample, and Nationwide Emergency Department Sample.

The study published by the American Diabetes Association compared hospital use among adults with and without diabetes across different age groups.

Researchers classified hospitalization diagnoses into three categories: traditional diabetes complications, emerging diabetes-associated conditions, and other co-occurring illnesses.

Traditional complications remained important. Sepsis, heart disease, acute kidney failure, heart attacks, and strokes accounted for substantial excess admissions. However, the study revealed that many additional conditions contributed to hospital use.

For example, excess admissions associated with sepsis ranged from approximately 1,571 per 100,000 adults with diabetes aged 18 to 44 to 2,623 among those aged 75 and older.

Importantly, the total burden of admissions involving emerging and other co-occurring conditions exceeded that of admissions classified as traditional complications across age groups.

This broader pattern challenges the idea that diabetes complications primarily involve blood vessels, kidneys, and the heart. Instead, comprehensive diabetes management must address a wider range of health concerns.

Infections, Respiratory Illness, and Other Emerging Risks

Infections and Respiratory Complications

Infections emerged as major contributors to hospital care among people with diabetes. Although sepsis remained a leading traditional complication, pneumonia and several other infections also accounted for substantial excess admissions.

Among adults aged 75 and older, pneumonia was associated with approximately 473 additional admissions per 100,000 people with diabetes compared with those without diabetes.

Meanwhile, skin infections, abscesses, cellulitis, and other infectious conditions frequently appeared among excess emergency department visits.

Respiratory disorders also played a significant role. Chronic obstructive pulmonary disease (COPD), asthma, and respiratory failure appeared among leading co-occurring conditions across age groups.

These findings highlight the importance of infection prevention, respiratory assessments, recommended vaccinations, and timely treatment.

Furthermore, infections can disrupt blood glucose management, increasing the risk of dehydration and serious metabolic complications.

Fluid Imbalances and Other Medical Conditions

Fluid and electrolyte disorders represented another notable finding.

Among adults aged 18 to 44, fluid, electrolyte, and acid-base disorders were associated with approximately 239 excess inpatient admissions per 100,000 people with diabetes.

Dehydration, vomiting, acute illness, and certain medications can contribute to fluid disturbances. Consequently, recognizing these problems early is an important part of diabetes care.

Digestive and urinary disorders were especially prominent among older adults. Device-related complications and procedure-related conditions also contributed to excess admissions.

Together, these findings show that people with diabetes are hospitalized for a wide range of conditions, not just poor blood glucose control or vascular complications.

Why Diabetes-Related Hospital Visits Differ by Age

Age played a major role in determining which conditions contributed most to hospital use.

Among younger adults, mental health conditions were particularly important. For example, schizoaffective disorders were associated with approximately 312 additional inpatient admissions per 100,000 adults with diabetes aged 18 to 44.

Bipolar disorder, other mental health conditions, and alcohol-related disorders also appeared among important contributors to excess admissions in younger patients.

These findings suggest that behavioral health deserves greater attention in routine diabetes management.

Mental health challenges can complicate medication routines, appointments, nutrition, and glucose monitoring. In addition, the daily demands of diabetes may create psychological stress that makes treatment more difficult.

For middle-aged adults, pneumonia, respiratory failure, liver-related illness, and device complications became increasingly prominent.

Older adults experienced greater burdens involving urinary disorders, digestive conditions, respiratory disease, and anemia.

Interestingly, younger adults often had higher relative risks compared with peers without diabetes. However, older adults generally experienced larger absolute excess burdens for major inpatient conditions.

Therefore, prevention strategies should reflect patient age, medical history, and individual health needs rather than relying on identical approaches for everyone.

Rethinking Prevention and Diabetes Care

The findings have important implications for clinicians, healthcare systems, and patients.

First, diabetes prevention strategies should extend beyond managing HbA1c, blood pressure, and cholesterol. Although these measures remain essential, they cannot address every condition contributing to acute hospital care.

Infection prevention, respiratory health, mental health screening, hydration assessment, and medication reviews should also receive attention.

Second, clinicians may benefit from developing age-specific care plans. Younger adults may need stronger behavioral health support, while older patients may benefit from coordinated care for multiple chronic conditions.

Third, patient education should emphasize recognizing early warning signs of illness.

For example, the CDC's diabetes sick-day guidance recommends monitoring glucose closely during illness and understanding when emergency care is necessary.

Additionally, the Diabetes in Control guide to sick-day management discusses how infections and acute illnesses can destabilize blood glucose levels.

Patients should review medication-specific sick-day instructions with their clinicians rather than stopping or changing treatment independently.

For personalized guidance, patients can also seek professional healthcare advice through Healthcare.pro.

However, the study has limitations. Its observational design cannot establish that diabetes directly caused each additional admission. The analysis also used 2019 data and could not distinguish repeat admissions involving the same patient.

Nevertheless, the research provides evidence that diabetes-associated acute healthcare use extends far beyond conventional complications.

Conclusion

Hospital care for people with diabetes extends well beyond the complications traditionally associated with the condition. Heart disease and kidney complications remain critical, but infections, respiratory illness, mental health disorders, and fluid imbalances also contribute substantially.

Furthermore, the reasons for acute hospital care change with age.

Ultimately, reducing preventable hospital visits may require more comprehensive, personalized diabetes care that addresses physical health, mental well-being, and coexisting medical conditions.

Frequently Asked Questions

1. What conditions most often lead to hospitalization in people with diabetes?

Major contributors include sepsis, cardiovascular disease, kidney failure, pneumonia, respiratory disorders, and fluid imbalances. However, the leading conditions vary by age and care setting.

2. Why are infections important for people with diabetes?

Certain infections may become more severe in people with diabetes. Additionally, acute illness can raise blood glucose and increase the risk of dehydration or metabolic emergencies.

3. How does mental health affect diabetes-related hospital visits?

Mental health disorders were prominent contributors to excess admissions among younger adults. Psychological challenges may also interfere with diabetes self-management and access to consistent care.

4. Are older adults more likely to experience diabetes-related hospital complications?

Older adults often experience greater absolute excess hospitalization burdens, particularly for infections and multiple chronic conditions. However, younger adults may have higher relative risks compared with people their age without diabetes.

5. Can comprehensive diabetes care help prevent hospitalizations?

Comprehensive care may help reduce some preventable emergencies. Alongside glucose management, infection prevention, mental health support, medication reviews, and clear sick-day plans can address important risks. However, not every hospitalization is preventable.

This content is not medical advice. For any health issues, always consult a healthcare professional. In an emergency, call 911 or your local emergency services.