Findings from a new study published in Diabetes Research and Clinical Practice reveal that some unexpected conditions such as iron deficiency anaemia are leading to more hospitalisations in people living with type 2 diabetes compared to the general population.
The emergence of iron deficiency anaemia, mental health disorders and gastrointestinal disorders as leading reasons for excess hospitalisation among those with type 2 diabetes compared to the general population came as a surprise.
The study from Baker Heart and Diabetes Institute found that people with type 2 diabetes are far more likely to be hospitalised with iron deficiency anaemia than those without diabetes.
“We’ve never seen this result described before,” said lead researcher, Professor Dianna Magliano. “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.”
The study used data from 456 265 people with type 2 diabetes registered in the National Diabetes Services Scheme between 2010–2017. Previous studies have assessed hospitalisations by disease group but this study is the first of its kind to delve into the specifics of hospitalisations for people living with type 2 diabetes.
“Because we now have better diabetes management, the proportion of those presenting to hospital with cardiovascular disease and kidney disease is reducing,” Prof Magliano said. “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.”
Prof 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.
Iron deficiency anaemia can cause fatigue, dizziness, a rapid or irregular heartbeat, and can put extra stress on the heart. It is usually easily treatable.
“Recognising 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 co-author Professor Jonathan Shaw.
The leading cause of excess hospitalisations for men living with type 2 diabetes was cellulitis, a well-known complication of diabetes. Other well-known complications that were responsible for large numbers of excess hospitalisations 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.
“In men, stress disorders accounted for the highest number of excess admissions of all diagnoses, with the exception of cellulitis,” Prof Magliano said. “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.
“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,” Prof Magliano said. “These are important findings that demonstrate the need to revise diabetes management to account for the changing spread of complications.”
