Risk factors

Changing profile of cardiovascular complications in T2D

Improvements in management of type 2 diabetes mean that traditional complications such as cardiovascular disease are being superseded by emerging ones such as anaemia, stress disorders and pneumonia, Australian researchers say.

While complications such as heart failure and cellulitis remain a substantial burden for people with T2D there have been significant changes in  the profile of leading causes of hospital admission, a study from the Baker Heart and Diabetes Institute, Melbourne has shown.

In findings to be presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm on 19 Sept researchers will show that only four traditional diabetes complications (cellulitis, heart failure, urinary tract infections, and skin abscesses ) now feature in the top ten causes of excess hospital admissions.

The findings come from an analysis of data from 456,265 people with T2D registered on the NDSS between 2010 and 2017, representing about half of Australians diagnosed with T2DM.

Diabetes complications were divided into three categories—traditional complications that included vascular diseases, kidney failure, retinopathy and cataracts, neuropathy, obesity, infections traditionally linked to diabetes (eg UTI), and complications of procedures related to well-known diabetes complications, such as amputation.

Emerging complications included liver disease, mental health disorders, various cancers, and infections less commonly associated with diabetes, such as respiratory infections and sepsis.

All other diagnoses were categorised as ‘not commonly acknowledged’ complications.

Overall, people with T2DM were shown to be at greater risk of being hospitalised with most medical conditions compared to the general population.

The leading cause of excess hospitalisations in men with T2D was cellulitis, responsible for 364 excess annual hospitalisations per 100,000 men, followed by the lesser-recognised complications of stress disorders (241 per 100,000) and iron deficiency anaemia (228 per 100,000). T2D was associated with a 2.0-2.5 fold increase in risk of admission for these conditions compared to the general population.

Other leading causes of excess hospitalisation among men with T2D included heart failure (157 per 100,000, relative risk 2.2), acute MI (152 per 100,000, RR 1.74) and conditions such as pneumonia, kidney and ureteric calculi, cutaneous abscess,  osteomyelitis, and gastroenteritis/colitis.

In women with T2DM, 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).

The only cardiovascular complication for women in the top ten for excess hospitalistion was heart failure (203 per 100,000, relative risk 2.55).

High rates of excess hospitalisation were 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 T2D compared to the general population.

Lead author Dr Dee Tomic from the Baker Heart and Diabetes Institute, said the findings showed that non-traditional complications of T2D now confer substantial health burdens that sometimes exceed the top-ranked well-known complications.

“The emergence of non-traditional diabetes complications reflects improvements in diabetes management and people with diabetes living longer, making them susceptible to a broader range of complications,” she 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,” Dr Tomic added.

Senior author Professor Dianna Magliano, Head of Diabetes and Population Health at Monash University, said the much greater risk for most mental health diagnoses in the diabetes population reinforced the evidence for mental health disorders as an emerging complication of T2D.

“The unexpected finding of a large burden of anaemia in both men and women with T2DM suggests the possibility of a biological link between diabetes and iron deficiency. To look at this and other novel findings in more detail, we must conduct further analyses as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and management strategies,” she said.

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.

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