A major UK-wide trial has found that the the oral anticoagulant apixaban does not help patients recovering from moderate and severe COVID compared to standard care – despite this approach being offered to patients.
To date, more than a thousand NHS patients hospitalised with COVID have taken part in HEAL-COVID, a platform trial that is aiming to find treatments to reduce the number who die or are readmitted following their time in hospital.
The trial’s preliminary results have shown that prescribing the oral anticoagulant Apixaban does not affect subsequent mortality or rehospitalisation of COVID over the following year (apixaban 29.1%, versus standard care 30.8%).
As well as being ineffective, anticoagulant therapy has known serious side effects, and these were experienced by participants in the trial with a small number of the 402 participants receiving apixaban discontinuing due to bleeding events.
There was also no benefit from Apixaban in terms of the number of days alive and out of hospital at day 60 after randomisation (apixaban 59 days, versus standard care 59 days).
Following these results, the trial will continue to test atorvastatin, which acts on other mechanisms of disease that are thought to be important in COVID.
Chief Investigator for the trial Professor Charlotte Summers is an intensive care specialist at Addenbrooke’s Hospital and the University of Cambridge. She said: “These first findings from HEAL-COVID show us that a blood thinning drug, commonly thought to be a useful intervention in the post-hospital phase is actually ineffective at stopping people dying or being readmitted to hospital. This finding is important because it will prevent unnecessary harm occurring to people for no benefit. It also means we must continue our search for therapies that improve longer term recovery for this devastating disease.”
HEAL-COVID enrols patients when they are discharged from hospital, following their first admission for COVID. They are randomised to a treatment and their progress tracked.
The common chemotherapy drug ifosfamide could leave a lasting toxic legacy for children and grandchildren of adolescent cancer survivors, suggests a study published online in iScience.
Researchers from Washington State University found that male rats given ifosfamide during adolescence had offspring and grand-offspring with increased incidence of disease. Other studies have shown that cancer treatments can increase patients’ chance of developing disease later in life, this is one of the first-known studies showing that susceptibility can be passed down to a third generation of unexposed offspring.
“The findings suggest that if a patient receives chemotherapy, and then later has children, that their grandchildren, and even great-grandchildren, may have an increased disease susceptibility due to their ancestors’ chemotherapy exposure,” said corresponding author Michael Skinner, a WSU biologist and corresponding author on the study.
Skinner emphasised that the findings should not dissuade cancer patients from undertaking chemotherapy since it can be a very effective treatment. Chemotherapy drugs kill cancerous cells and stop multiplication, but have many side effects, including on reproductive systems.
The researchers therefore recommend that cancer patients who plan to have children later take precautions, such as using cryopreservation to freeze sperm or ova before having chemotherapy.
In the study, researchers exposed a set of young male rats to ifosfamide over three days, mimicking a course of treatment an adolescent human cancer patient might receive. Those rats were later bred with unexposed female rats. The resulting offspring were bred again with another set of unexposed rats.
The first-generation offspring had some exposure to the chemotherapy drug since their fathers’ sperm was exposed, but researchers found greater incidence of disease in not only the first- but also the second-generation, who had no direct exposure to the drug. While there were some differences by generation and sex, the associated problems included greater incidence of kidney and testis diseases as well as delayed onset of puberty and abnormally low anxiety, indicating a lowered ability to assess risk.
The researchers also looked for epigenetic changes. Previous research has shown that exposure to toxicants, particularly during development, can create epigenetic changes that can be passed down through sperm and ova.
The results of the researchers’ analysis showed epigenetic changes in two generations linked to the chemotherapy exposure of the originally exposed rats. The fact that these changes could be seen in the grand-offspring, who had no direct exposure to the chemotherapy drug, indicates that the negative effects were passed down through epigenetic inheritance.
Skinner and colleagues at Seattle Children’s Research Institute are currently working on a human study with former adolescent cancer patients to learn more about the effects chemotherapy exposure has on fertility and disease susceptibility later in life.
A better knowledge of chemotherapy’s epigenetic shifts could also help inform patients of their likelihood of developing certain diseases, creating the possibility of earlier prevention and treatment strategies, Skinner said.
“We could potentially determine if a person’s exposure had these epigenetic shifts that could direct what diseases they’re going to develop, and what they’re going to potentially pass on to their grandchildren,” he said. “We could use epigenetics to help diagnose whether they’re going to have a susceptibility to disease.”
In many trials testing cannabis for pain relief, there is no significant difference between placebo and the active cannabinoid substance. Still, these studies receive significant media coverage regardless of the clinical outcome, according to a study published in JAMA Network Open.
“We see that cannabis studies are often described in positive terms in the media regardless of their results,” says the study’s first author Filip Gedin, postdoc researcher at Karolinska Institutet. “This is problematic and can influence expectations when it comes to the effects of cannabis therapy on pain. The greater the benefit a treatment is assumed to have, the more potential harms can be tolerated.”
The study is based on an analysis of published clinical studies in which cannabis has been compared with placebo for the treatment of clinical pain. The change in pain intensity before and after treatment were the study’s primary outcome measurement.
The analysis drew on 20 studies published up to September 2021 involving almost 1500 individuals.
No difference between cannabis and placebo
The results of the study show that pain is rated as being significantly less intense after treatment with placebo, with a moderate to large effect. The researchers also observed no difference in pain reduction between cannabis and placebo, which corroborates results from another recently published meta-analysis.
“There is a distinct and clinically relevant placebo response in studies of cannabis for pain,” says Dr Gedin.
The researchers also examined a possible connection between the magnitude of the therapeutic effect shown by the cannabis studies and the coverage they receive in the media and in academic journals. Media presence was measured through Altmetric, which is a method of evaluating mentions in the media, in blogs and on social media. Academic impact was measured in terms of citations by other researchers.
The analysis of media presence included a total of 136 news items in traditional media and in blogs and was categorised as positive, negative or neutral, depending on how the results were presented concerning the effectiveness of cannabis as a treatment for pain.
Lots of media attention
The researchers found that the cannabis studies received much greater media attention than other published studies. The coverage was substantial regardless of the magnitude of the placebo response and regardless of the therapeutic effect of cannabis. They also observed no link between the proportion of positively described news about a study and the effect it reported.
The researchers add the caveat that their study combined trials of varying designs and quality and therefore the results should be interpreted with caution.
This research was financed by Riksbankens Jubileumsfond (Karin Jensen). The researchers report no potential conflicts of interest.
Older adults living in areas with greater age bias had better health outcomes than those in areas with less bias, according to a study published in Social Science & Medicine. These findings came as a surprise to the researchers, who were expecting the reverse.
“Quite the opposite of what we expected emerged,” says senior author Allecia Reid, associate professor of social psychology and senior author of the paper published in the journal . “Rather than dying earlier in counties with more negative attitudes toward older adults, we found in fact that older adults were living longer in counties with more negative attitudes towards older adults.”
University of Massachusetts Amherst researcher Reid and colleagues had based their hypothesis on earlier research showing that minority groups, such as African Americans and sexual minorities, have worse health outcomes in counties with more negative attitudes toward their group.
“We were thinking, similar to those findings, that in counties with more negative attitudes towards older adults, we would see them being likely to die earlier than in counties with more positive attitudes toward residents 65 and older,” Reid says. “Contrary to what we thought, something positive is happening in these ageist communities that is helping them live longer, healthier lives.”
The only other study examining community-level age bias and older adults’ health found that explicit age bias was linked to positive health behaviours among older adults, while implicit bias was linked to negative health behaviours among older adults.
The UMass Amherst researchers analysed data on more than one million Americans who reported their explicit bias and taken an implicit bias test between 2003 and 2018
Based on that data, the team developed aggregate estimates at the county level about how much residents like older adults. Then they linked that with the county’s death rates for individuals age 65+. Counties with higher explicit age bias had lower mortality, or 87.67 fewer deaths per 100 000 residents. In contrast, implicit bias was not associated with mortality outcomes.
“The explicit age bias-mortality association was only evident in communities with younger populations but did not depend on community ethnic composition,” the paper states.
The researchers looked at ways that the more ageist communities might be doing things that helped maintain the health of older adults. They found that greater explicit age bias also was associated with lower death rates among young and middle-aged adults in those counties, suggesting that any health benefits of living in ageist communities may begin to accrue in earlier life.
In addition, “communities with higher explicit age bias also had higher rates of exercise…, better general health…, and more days of good mental health,” the paper states. These findings point to potential pathways through which ageist communities may promote health. However, the researchers also note that factors they were unable to examine, such as better medical care and more green spaces, may also explain associations of community age bias with better health.
Reid says the surprising findings point to more areas of examination which may lead to improved longevity for all communities.
“Can we figure out what is happening in these more ageist communities that seems to be potentially promoting both better mental health and better longevity,” she says. “And if we can pinpoint those things, then that’s a flag for all communities to think about.”
A large international study reveals a wide range in the amount of water people consume around the globe and over their lifespans, which pours cold water on the oft-repeated idea that the human body needs eight glasses a day. In the study, which appears in Science, some may need up to six litres a day while others get by with only one litre.
“The science has never supported the old eight glasses thing as an appropriate guideline, if only because it confused total water turnover with water from beverages and a lot of your water comes from the food you eat,” says Dale Schoeller, emeritus professor at University of Wisconsin-Madison. “But this work is the best we’ve done so far to measure how much water people actually consume on a daily basis — the turnover of water into and out of the body — and the major factors that drive water turnover.”
That’s not to say the new results settle on a new guideline. The study, measured the water turnover of more than 5600 people from 26 countries, ages ranging from 8 days to 96 years old, and found daily averages on a range between 1 and 6 litres per day.
“There are outliers, too, that are turning over as much as 10 litres a day,” says Schoeller, a co-author of the study. “The variation means pointing to one average doesn’t tell you much. The database we’ve put together shows us the big things that correlate with differences in water turnover.”
Previous studies of water turnover relied largely on volunteers to recall and self-report their water and food consumption, or were focused observations — of, say, a small group of young, male soldiers working outdoors in desert conditions — of questionable use as representative of most people.
The new research objectively measured the time it took water to move through the bodies of study participants by following the turnover of “labelled water”, which contains hydrogen and oxygen isotopes.
“If you measure the rate a person is eliminating those stable isotopes through their urine over the course of a week, the hydrogen isotope can tell you how much water they’re replacing and the elimination of the oxygen isotope can tell us how many calories they are burning,” says Schoeller, whose UW-Madison lab in the 1980s was the first to apply the labelled-water method to study people.
More than 90 researchers were involved in the study, which was led by a group that includes Yosuke Yamada, a former UW-Madison postdoctoral researcher in Schoeller’s lab and now section head of the National Institute of Biomedical Innovation, Health and Nutrition in Japan, and John Speakman, zoology professor at the University of Aberdeen in Scotland. They collected and analysed data from participants, comparing environmental factors – such as temperature, humidity and altitude of the participants’ hometowns – to measured water turnover, energy expenditure, body mass, sex, age and athlete status.
The researchers also incorporated the United Nations’ Human Development Index, a composite measure of a country that combines life expectancy, schooling and economic factors.
Water turnover volume peaked for men in the study during their 20s, while women held a plateau from 20 through 55 years of age. Newborns, however, turned over the largest proportion daily, replacing about 28% of the water in their bodies every day.
Physical activity level and athletic status explained the largest proportion of the differences in water turnover, followed by sex, the Human Development Index, and age.
All things equal, men and women differ by about half a litre of water turnover. As a baseline of sorts, the study’s findings expect a male non-athlete (but of otherwise average physical activity) who is 20 years old, weighs 70kg, lives at sea level in a well-developed country in a mean air temperature of 10°C and a relative humidity of 50%, would take in and lose about 3.2 litres of water every day. A woman of the same age and activity level, weighing 60kg and living in the same spot, would go through 2.7 litres.
Doubling the energy a person uses will push their expected daily water turnover up by about litre, the researchers found. Fifty kilograms more body weight adds 0.7 litres a day. A 50% increase in humidity pushes water use up by 0.3 litres. Athletes use about a litre more than non-athletes.
The researchers found “hunter-gatherers, mixed farmers, and subsistence agriculturalists” all had higher water turnover than people who live in industrialised economies. In all, the lower your home country’s Human Development Index, the more water you go through in a day.
“That’s representing the combination of several factors,” Schoeller says. “Those people in low HDI countries are more likely to live in areas with higher average temperatures, more likely to be performing physical labour, and less likely to be inside in a climate-controlled building during the day. That, plus being less likely to have access to a sip of clean water whenever they need it, makes their water turnover higher.”
The measurements will improve our ability to predict more specific and accurate future water needs, especially in dire circumstances, according to Schoeller.
A new study published in PLOS ONE estimates that over a million lives were lost in Russia to the COVID pandemic. In the study, the researchers also introduce an improved methodology for future pandemics, which counts a victim’s remaining number of expected years of life lost.
Calculating COVID pandemic mortality is crucial for future epidemiological and policy decisions. Getting a reliable estimate is however complicated by incomplete or inadequate registration data, difficulties in determining the primary cause of death, or challenges in tracking down indirect effects.
This is especially the case in Russia, where mortality estimates from COVID showed a high degree of uncertainty, with varying estimates reported by different studies within and outside of Russia. The country has also received international attention due to the especially high reported mortality compared to other parts of the world. To improve estimates on the human cost of the pandemic in Russia, an international team of researchers led by IIASA conducted the most detailed analysis on pandemic mortality in the country to date.
“While national figures show that excess mortality in Russia is perhaps among the highest in the world, there is a wide degree of regional variation that deserves further analysis,” says Stuart Gietel-Basten, a researcher at The Hong Kong University of Science and Technology and a coauthor of the study. “Such variation is key to devising better public health strategies to mitigate both the ongoing impact of COVID, and to rebuild and reshape health systems after the pandemic is over.”
The researchers used the concept of ‘excess mortality’ that looks at the difference between the actual number of deaths and what would have been expected if there was no pandemic. Unlike other measures, excess mortality includes deaths that may have stemmed from lockdowns, restriction on movement, postponed operations, and so on, giving a much more comprehensive and reliable estimate.
The team used the latest data released from the Russian Federal State Statistics Service and calculated excess mortality for Russia and its regions for 2020 and 2021, and for 2020 also assessing mortality by age, sex, and rural-urban residence. In 2020 and 2021, the researchers estimated over one million Russian lives lost to COVID.
“A number of researchers within Russia and outside had more or less similar estimates,” says Sergei Scherbov, lead author of the study and a researcher in the IIASA Population and Just Societies Program. “However, due to the advanced population projection methodology and software that we have developed at IIASA, we were able to make population projections for all regions, subdividing urban and rural populations, as well as gender and age groups. This allowed us to produce a very detailed estimate of excess mortality from COVID in Russia and its regions.”
One of the study’s main findings was that different regions within the country differed greatly in mortality. In 2021, excess deaths expressed as a percentage of expected deaths at the regional level ranged from 27% to 52%, with urban regions generally faring worse. The researchers suggested that apart from population density, socio-cultural, economic and, perhaps, geographic differentials could have contributed to the differences.
“Regions of the Northern Caucasus reporting high excess mortality are known for their tradition of elderly living in larger households of extended families together with their children and descendants,” explains Dalkhat Ediev, study coauthor and researcher in the IIASA Population and Just Societies Program. Such a tradition might have contributed to higher social exposure and, hence, higher losses.”
The study also introduced a new measure called the Mean Remaining Life Expectancy of the Deceased, showing how many years on average those whose death was among the excess deaths lost. They found that for Russia as a whole, an average person who died due to the pandemic in 2020 would have otherwise lived on average for a further 14 years.
“This finding disproves the widely held view that excess mortality during the pandemic period was concentrated among those with few years of life remaining — especially for females,” notes Scherbov.
The new and improved estimates will not only help policymakers in case of future decisions on mitigation strategies, but also take a major methodological step forward, helping us get a clearer view of pandemics in the future.
As we approach World AIDS Day on 1 December, healthcare providers will be offering HIV screening and testing as part of a comprehensive health service.
One aspect in which more equality is arguably needed is between the quality of HIV testing services and aiming to test as many people as possible.
Progress against targets?
It is estimated that 13.9% of South Africa’s population is living with HIV and that the absolute number of people living with HIV in the country has increased from 3.8 million in 2002 to 7.8 million in 2021. This number has continued to rise since the death rate has declined much more rapidly than the rate of new HIV infections.
The most widely used measure of a country’s HIV response in recent years has been the UNAIDS 90-90-90 targets. These aim at 90% of people living with HIV knowing their status, 90% of those diagnosed started on ARVs, and 90% of those on ARVs being virally suppressed by 2020. The goal post has now shifted to 95-95-95.
Earlier this year, Health Minister Dr Joe Phaahla said that in South Africa we are on 94-78-89.
This indicates that we are close to reaching the first 95. It also suggests that our HIV testing efforts have generally been a success, including the introduction of HIV Rapid Testing and HIV Self Screening as HIV testing models. But, as we collectively meet these targets, it is important to focus on the quality of HIV rapid testing to ensure that we align with HIV testing standards.
Focus on quality
The quality of HIV Rapid testing to some extent depends on laboratories, but often it is driven by HIV counsellors and service delivery NGOs. As a public health professional managing the National HIV Testing Quality Assurance and Laboratory Systems Strengthening programme, seconded to the Department of Health through SEAD Consulting, it is my job to support NGOs, the Department of Health, and the Department of Correctional Services in implementing quality assurance of HIV Testing and in improving the laboratory systems between health facilities and the National Health Laboratory Service.
As someone who has worked in all aspects of primary healthcare, I am painfully aware of the shortcuts sometimes taken, but also of the impossible expectation of ‘quick services’ linked to HIV testing.
As a healthcare provider, I received peer mentorship upon entry into primary healthcare settings – but I later learnt that this mentorship provided incorrect guidance on HIV testing.
This gave me sleepless nights and fuelled my desire to support other healthcare workers in conducting quality HIV testing to avoid possible misdiagnosis and delays to critical treatment. It is imperative that everyone understands their role when it comes to HIV testing and that we move away from siloed approaches in prevention and curative spaces but integrate both quality and ambitious targets. One cannot be seen in isolation from the other.
So, how are HIV tests supposed to be done?
Firstly, there are multiple things to look out for when having an HIV test done. HIV testing should be conducted by a trained healthcare worker, using nationally approved test kits which are kept in temperature-controlled spaces. Test kits should not be exposed to extreme heat of more than 30 degrees Celsius as it fries the device, which could lead to incorrect results.
Secondly, each test has an expiry date, its own pipette (plastic or glass device to collect the blood), its own buffer (liquid that assists the blood to move across the test strip) and its own incubation time (time it takes for a reaction or outcome of the test).
When being tested, the fingertip needs to be cleaned with an alcohol-based swab, and then the first drop of blood should be wiped away to avoid contamination of the sample. The second drop of blood is then collected with the specific pipette to the required amount for that test. Once collected, the blood is inserted into the well of the test and the required number of drops of buffer is added. Lastly, the timer is set to the manufacturer’s time for each test kit.
The time is of utmost importance, as reading it too early could lead to false HIV-negative results, whereas reading it too long after the time could lead to false HIV-positive results. It is for this reason that each HIV tester needs to have a digital timer that is able to count down and sound an alarm when the time has been reached.
Additional aspects linked to the quality of HIV testing are Personal Protective Equipment (Aprons, gloves, and sanitiser) – these need to be worn by the HIV tester as part of infection control. Also important are ice packs – if you are being tested in a gazebo in the community, the HIV tester needs to ensure that the HIV test kits are kept cool to avoid malfunction or damage.
These are the basics we must get right.
The quality of HIV testing is as important as getting the test done. Too often short cuts, time constraints, and lack of staff impact the quality of testing. To be in a position where we can really celebrate the numbers – the progress – it is essential that we must get these basics right.
*Sparks is a Public Health Professional at SEAD consulting, a co-convenor at the School of Public Health, University of the Western Cape, a Senior Aspen New Voices Fellow, and a Global Atlantic Fellow for Health Equity.
A large-scale study published in JAMA Network has found no link between benzodiazepines use in pregnancy and subsequent autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) diagnoses in offspring. When comparing siblings, benzodiazepines use had no effect on ASD or ADHD risk, indicating that the mother’s genetics partly explained the increased risk.
Some 10–30% of pregnant women experience mental disorders, including mood or anxiety spectrum disorders, for which benzodiazepine agents are sometimes prescribed; this occurs in an estimated 1.9% of pregnancies globally.
The safety of these agents to the developing foetus and newborn has been called into question, since benzodiazepines are able to cross the placenta and have been found to be present in amniotic fluid and breast milk. The US FDA includes in the category of possible harm to the foetus.
While rodents studies have tested benzodiazepine exposure during the first trimester of pregnancy, investigations of neurodevelopmental outcomes in humans, such as ASD and ADHD, have been lacking.
One study found no significantly increased risks of ADHD symptoms or fine or greater motor deficits. Those researchers suggested the disorder resulting in benzodiazepine use might partly explain the increased risks. Maternal depressive and anxiety symptoms in pregnancy have also been linked to increased ADHD risk in children.
From the Taiwanese national health database, of over 1 .5 million children born full term who were younger than 14 years of age and followed up to 2017; 5.0% had been exposed to benzodiazepines in utero.
However, no differences were found with unexposed sibling controls during the same time frame for ADHD or ASD.
The researchers concluded that their results “challenge current assumptions of a potential association of neurodevelopmental disorders with maternal benzodiazepine use before or during pregnancy. Better identification of maternal mental health concerns, as well as possible interventions or provisions of guidance to build better nurturing and raising environments for newborns at risk, may be relevant to the prevention of adverse outcomes of neurodevelopmental disorders.”
In a population-based study published in Arthritis & Rheumatology, researchers found that men with metabolic syndrome (MetS) and those who developed MetS – especially those with the MetS components of elevated triglycerides and abdominal obesity – were at higher risk of developing gout.
Gout is one of the most common causes of chronic inflammatory arthritis, characterised by monosodium urate (MSU) monohydrate crystals deposition in the tissues.
Dietary sources that can contribute to hyperuricemia and gout include the consumption of animal food such as seafood (eg, shrimp, lobster), organs (eg, liver and kidney), and red meat (pork, beef). Some drinks like alcohol and sweetened drinks may also contribute to this disease. Epidemiological studies reported an increased disease burden of gout, which is largely explained by lifestyle changes like increased protein consumption and a sedentary lifestyle.
The study included nearly 1.3 million men aged 20–39 years who participated in three serial health check-ups at two-year intervals. Among these participants, 18 473 developed gout, and those with MetS at all checkups had a nearly four-fold higher risk than participants who were MetS-free. Development of MetS more than doubled the risk of incident gout. Conversely, recovery from MetS reduced incident gout risk by nearly half.
Among MetS components, changes in elevated triglycerides and abdominal obesity displayed the greatest association with altered risk of incident gout. Age was also a factor: associations among MetS changes and incident gout were more pronounced in subjects in their 20s than subjects in their 30s and in subjects who were under- or normal weight.
“This is the first large-scale study to explore the association between dynamic changes in MetS and risk of gout,” said co–corresponding author Jaejoon Lee, MD, PhD of the Sungkyunkwan University School of Medicine, in South Korea. “Prevention and recovery from MetS can significantly lower the risk of gout in young adults.”
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.”
