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Diabetes, prediabetes increase all-cause hospitalization rates
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.
“Our results suggest that prevention of prediabetes from progression to overt diabetes and improved glycemic control among those with diagnosed diabetes may reduce the burden of hospitalizations over the life span,” Andrea L. C. Schneider, MD, PhD, of the department of neurology at Johns Hopkins, told Endocrine Today. “The high rate of hospitalization due to endocrine, infection and iatrogenic/injury causes among those with diagnosed diabetes is concerning and suggests that increased efforts are needed to reduce the burden of preventable hospitalization among persons with diabetes.”
Andrea L. C. Schneider
Schneider and colleagues analyzed data from 13,522 adults participating in the ARIC study, recruited from 1987 to 1989 from suburbs in Minnesota, Maryland, North Carolina and Mississippi (mean age, 57 years; 56% women; 24% black). Within the cohort, 17.8% had prediabetes at baseline (visit two; 1990-1992), 4.1% had undiagnosed diabetes, and 9.3% had diabetes and were followed from 1990 to 2011 for any cause of hospitalizations.
Researchers found that demographic-adjusted rates per 1,000 person-years of all-cause hospitalizations were higher with increasing diabetes/HbA1c category (P trend < .001). Participants with diagnosed diabetes and an HbA1c of at least 7% were 3.5 times more likely to be hospitalized than those without a history of diagnosed diabetes and an HbA1c of 5.7% or less (P < .001), and 1.5 times more likely to be hospitalized than those with diabetes and an HbA1c of 7% or less (P < .001).
Among participants without a history of diagnosed diabetes, those with an HbA1c of at least 6.5% were 1.6 times more likely to be hospitalized than those with an HbA1c of 5.7% or less (P < .001); those with prediabetes (HbA1c, 5.7%-6.5%) were 1.3 times more likely to be hospitalized than those with an HbA1c of 5.7% or less (P < .001).
Rates of hospitalization by diabetes and HbA1c category differed by race and sex, but not by age, according to researchers. Blacks were more likely to be hospitalized than whites for all categories except prediabetes and undiagnosed diabetes (P = .011 for interaction); men were more likely to be hospitalized than women in all categories except those with diabetes and an HbA1c of at least 7% (P = .02 for interaction).
Researchers found that participants with diagnosed diabetes experienced significantly excessive rates of hospitalization for cardiovascular, endocrine, respiratory, gastrointestinal, iatrogenic/injury, neoplasm, genitourinary, neurologic and infection causes vs. those without diagnosed diabetes (P < .05 for all). – by Regina Schaffer
For more information:
Andrea L. C. Schneider, MD, PhD , can be reached at Johns Hopkins Hospital, 1800 Orleans St., Baltimore, MD 21287; email: Achris13@jhmi.edu.
Disclosure: The researchers report no relevant financial disclosures.