New research coming out of Australia shows that the most common reasons for people with type 2 diabetes being hospitalised with greater frequency than the general population are changing.

According to national data, spanning seven years, hospitalisations for traditional diabetes complications are now being accompanied by admissions for lesser known complications, including infections, gastrointestinal conditions and mental health disorders.

Only four traditional diabetes complications – cellulitis, heart failure, urinary tract infections, and skin abscesses – were in the top 10 leading causes of hospitalisation.

Top author Dr Dee Tomic said: “Increasing hospitalisations for mental health disorders as well as infections like sepsis and pneumonia will place extra burden on healthcare systems and may need to be reflected in changes to diabetes management to better prevent and treat these conditions.”

The researchers analysed data from around 50 per cent of Australians diagnosed with type 2 diabetes from the Australian Diabetes Registry (the National Diabetes Services Scheme; NDSS).

In total, 456,265 individuals, aged 15 years and older, with type 2 diabetes registered on the NDSS between 2010 and 2017 were linked with hospital data and compared to over 19 million Australians aged 15 and above.

Modelling was used to identify the leading individual diagnosis-level causes of hospitalisation among people with type 2 diabetes and to estimate the relative risk of hospitalisation compared to the general population, after adjusting for age and calendar-year effects. Admissions for type 2 diabetes itself were excluded from the analyses.

Overall, the analyses found that people with type 2 diabetes are at greater risk of being hospitalised with most medical conditions compared to the general population.

The leading cause of excess hospitalisations in men with type 2 diabetes was cellulitis, responsible for 364 excess annual hospitalisations per 100,000 men with type 2 diabetes. This was followed by the lesser-recognised complications of stress disorders (241 per 100,000) and iron deficiency anaemia (228 per 100,000) — with diabetes doubling the risk of admission for these conditions compared to the general population.

In women with type 2 diabetes, iron deficiency anaemia was the leading cause of excess annual admissions (558 per 100,000), followed by the traditional complications of urinary tract infections (332 per 100,000) and cellulitis (267 per 100,000).

High rates of excess hospitalisation were also noted for lesser-known complications including depression (256 per 100,000), gastrointestinal disorders (237 per 100,000) and asthma (192 per 100,000) — with hospitalisations for asthma more than twice as likely amongst women with type 2 diabetes compared to the general population.

The authors acknowledge that their findings show observational associations rather than cause and effect.

They also note some limitations, including that the study included people from one high-income country with a predominantly white Caucasian population, so the findings cannot be generalised to low- and middle-income countries.

Additionally, they were unable to exclude people with diabetes from the general population, so the strength of the associations might be reduced compared to an analysis of people with versus without diabetes.

The findings were presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden in September.