The Lancet Magazine's new year's heavyweight: 300,000 15-year data revealed!

As we all know, diabetes can cause many complications, including acute metabolic decompensation such as diabetic ketoacidosis, macrovascular diseases such as ischemic heart disease, stroke, and microvascular complications such as kidney disease, retinopathy, and peripheral neuropathy
.

Because of these complications can be carried out by traditional evidence-based interventions largely prevention , so they have become the event for future diabetes guidelines focus

Guidelines for Diabetes Vascular Prevention

Previous studies have found that the non-fatal incidence of these traditional diabetic complications is declining, parallel to the decline in all-cause mortality in diabetic patients
.

In this context, the greatest decrease in mortality was attributed to the reduction of major vascular causes; however, the influencing factors may be mixed

Previous studies have found that the non-fatal incidence of these traditional diabetic complications is declining, parallel to the decline in all-cause mortality in diabetic patients

Unique complications, but also because of other diseases, these diseases are likely to account for a large proportion of hospitalized cases, and the proportion is still increasing

In this epidemiological analysis, we identified 309,874 diabetic patients (type 1 or type 2) aged 18 years or older from the clinical practice research data link of hospital case statistics from 2003 to 2018 inpatient data
.

Through continuous cross-section and follow-up over time, a research population with mixed epidemics and onset diabetes was generated

In this epidemiological analysis, we identified 309,874 diabetic patients (type 1 or type 2) aged 18 years or older from the clinical practice research data link of hospital case statistics from 2003 to 2018 inpatient data

Among the individuals included in the study, there were approximately 51,000 men and 44,000 women in the diabetic population in 2003, and 117,000 men and 102,000 women in 2018

At the beginning and end of the study period, the hospitalization rates for all study reasons were higher for diabetic patients than for non-diabetic patients (Table 2; Figure 1)
.

The excess hospitalization rate (the absolute difference in the adjusted hospitalization rate between diabetic and non-diabetic patients) varies by gender and time

At the beginning and end of the study period, the hospitalization rates for all study reasons were higher for diabetic patients than for non-diabetic patients (Table 2; Figure 1)

Trends in hospitalization rates vary greatly from group to group
.

Hospitalization rates due to vascular disease, diabetes, and amputations declined between 2003 and 2018.

Trends in hospitalization rates vary greatly from group to group

Although the hospitalization rate for diabetes-related complications declined between 2003 and 2018, the rate of decline in hospitalization rates due to ischemic heart disease, diabetes, acute myocardial infarction, stroke, and major amputations in subsequent years It has slowed down (Figure 3A, Figure 3B)
.
2 007 years later, the rate of hospitalization for minor amputation and only a slight decline in 2005-2011, chronic kidney disease hospitalization rate declined steadily from 2012 to 2018 after which the decline is much flat (in 2011 there is a clear Negative peak)
.
During this period, the trend in hospitalization rates for non-specific diabetes complications was generally more uniform, with the largest increase in hospitalization rates observed due to all other cancers, respiratory infections, and sepsis ; the latter increased significantly in 2017-18 (Figure 3C)
.

Although the hospitalization rate for diabetes-related complications declined between 2003 and 2018, the rate of decline in hospitalization rates due to ischemic heart disease, diabetes, acute myocardial infarction, stroke, and major amputations in subsequent years It has slowed down (Figure 3A, Figure 3B)
.
2 007 years later, the rate of hospitalization for minor amputation and only a slight decline in 2005-2011, chronic kidney disease hospitalization rate declined steadily from 2012 to 2018 after which the decline is much flat (in 2011 there is a clear Negative peak)
.
During this period, the trend in hospitalization rates for non-specific diabetes complications was generally more uniform, with the largest increase in hospitalization rates observed due to all other cancers, respiratory infections, and sepsis ; the latter increased significantly in 2017-18 (Figure 3C)
.
Although the hospitalization rate for diabetes-related complications declined between 2003 and 2018, the rate of decline in hospitalization rates due to ischemic heart disease, diabetes, acute myocardial infarction, stroke, and major amputations in subsequent years It has slowed down (Figure 3A, Figure 3B)
.
2 Overall, the largest increase in hospitalization rates was observed; the latter increased significantly in 2017-18 (Figure 3C)
.

During the 16-year study period, the heterogeneity trend of different diseases led to the diversification of hospitalization reasons, away from diabetes-specific complications
.
From 2003 to 2018, the proportion of men hospitalized for vascular diseases fell from 31% to 20%, and women’s from 28% to 16% (Figure 4; Appendix 3-6)
.
The combination of the three traditional diabetes-specific complications of blood vessels, diabetes and amputation accounted for about half of the burden of hospitalization for all causes in 2003 (58% for men and 49% for women), which dropped to nearly one-third in 2018 ( 38% of men and 28% of women)
.
In contrast, the proportion of men hospitalized for cancer increased from 17% in 2003 to 21% in 2018, and women increased from 16% in 2003 to 20% in 2018.
The increase in hospitalizations caused by non-diabetic-related cancers is much greater than that of diabetes.
Related cancers (Figure 4; Appendix pages 3-6)
.
The proportion of hospitalizations due to infection increased the most.
Among them, the number of males hospitalized for respiratory infections increased from 4.
3% to 10.
6%, and females from 4.
6% to 12.
4%
.
Among men and women, the number of people hospitalized for sepsis increased from 1% to 6%
.

During the 16-year study period, the heterogeneity trend of different diseases led to the diversification of hospitalization reasons, away from diabetes-specific complications
.
From 2003 to 2018, the proportion of men hospitalized for vascular diseases fell from 31% to 20%, and women’s from 28% to 16% (Figure 4; Appendix 3-6)
.
The combination of the three traditional diabetes-specific complications of blood vessels, diabetes and amputation accounted for about half of the burden of hospitalization for all causes in 2003 (58% for men and 49% for women), which dropped to nearly one-third in 2018 ( 38% of men and 28% of women)
.
In contrast, the proportion of men hospitalized for cancer increased from 17% in 2003 to 21% in 2018, and women increased from 16% in 2003 to 20% in 2018.
The increase in hospitalizations caused by non-diabetic-related cancers is much greater than that of diabetes.
Related cancers (Figure 4; Appendix pages 3-6)
.
The proportion of hospitalizations due to infection increased the most.
Among them, the number of males hospitalized for respiratory infections increased from 4.
3% to 10.
6%, and females from 4.
6% to 12.
4%
.
Among men and women, the number of people hospitalized for sepsis increased from 1% to 6%
.
During the 16-year study period, the heterogeneity trend of different diseases led to the diversification of hospitalization reasons, away from diabetes-specific complications
.
From 2003 to 2018, the proportion of men hospitalized for vascular diseases fell from 31% to 20%, and women’s from 28% to 16% (Figure 4; Appendix 3-6)
.
The combination of the three traditional diabetes-specific complications of blood vessels, diabetes and amputation accounted for about half of the burden of hospitalization for all causes in 2003 (58% for men and 49% for women), which dropped to nearly one-third in 2018 ( 38% of men and 28% of women)
.
In contrast, the proportion of men hospitalized for cancer increased from 17% in 2003 to 21% in 2018, and women increased from 16% in 2003 to 20% in 2018.
The increase in hospitalizations caused by non-diabetic-related cancers is much greater than that of diabetes.
Related cancers (Figure 4; Appendix pages 3-6)
.
The proportion of hospitalizations due to infection increased the most.
Among them, the number of males hospitalized for respiratory infections increased from 4.
3% to 10.
6%, and females from 4.
6% to 12.
4%
.
Among men and women, the number of people hospitalized for sepsis increased from 1% to 6%
.

In summary, during the entire study period, the hospitalization rate of diabetic patients for all reasons was higher than that of non-diabetic patients
.
Diabetes itself and ischemic heart disease were the main reasons for excessive hospitalization in 2003 (defined as the difference in absolute hospitalization rates between diabetic and non-diabetic patients)
.
By 2018, non-communicable and non-cancerous respiratory diseases, non-diabetic-related cancers, and ischemic heart disease are the most common causes of excessive hospitalization in men and women
.
The hospitalization rate of diabetic patients has decreased, and the reasons for hospitalization have changed
.
Almost all traditional diabetic complications (vascular disease, amputation, and diabetes) have decreased, while non-diabetic-specific diseases (cancer, infection, non-infectious and non-cancerous respiratory diseases) have increased
.
These different trends represent changes in the reasons for hospitalization.
For example, in 2003, complications of traditional diabetes accounted for more than 50% of hospitalizations, but only about 30% in 2018
.
In contrast, the proportion of hospitalizations due to respiratory infections during the same period increased from 3% to 10% among men, and from 4% to 12% among women
.

Throughout the study period, the hospitalization rate of diabetic patients for all reasons was higher than that of non-diabetic patients
.
Diabetes itself and ischemic heart disease were the main reasons for excessive hospitalization in 2003 (defined as the difference in absolute hospitalization rates between diabetic and non-diabetic patients)
.
By 2018, non-communicable and non-cancerous respiratory diseases, non-diabetic-related cancers, and ischemic heart disease are the most common causes of excessive hospitalization in men and women
.
Almost all traditional diabetic complications (vascular disease, amputation, and diabetes) have decreased, while non-diabetic-specific diseases (cancer, infection, non-infectious and non-cancerous respiratory diseases) have increased
.
For example, in 2003, traditional diabetes complications accounted for more than 50% of hospitalizations, but in 2018 they accounted for only about 30%
.

The changes in the composition of the excess risk and hospitalization burden of diabetic patients mean that preventive and clinical measures should be continuously developed to reflect the various reasons that lead to the continued excessive hospitalization of diabetic patients
.

The changes in the composition of the excess risk and hospitalization burden of diabetic patients mean that preventive and clinical measures should be continuously developed to reflect the various reasons that lead to the continued excessive hospitalization of diabetic patients
.

 

Original source:

Jonathan Pearson-Stuttard , et al.
Trends in leading causes of hospitalisation of adults with diabetes in England from 2003 to 2018: an epidemiological analysis of linked primary care records.

Pearson-Stuttard Jonathan Lancet Endocrinol Diabetes.
Lancet Endocrinol Diabetes.
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