Youth T1D ups hospitalisation risk for ‘almost all’ conditions

Type 1 diabetes

By Geir O'Rourke

12 Sep 2023

Young patients with T1D are more likely to be hospitalised for almost all conditions than the general population, although the majority of their admissions are for diabetes-related reasons, Australian data show.

Underscoring the importance of patient and carer education, around 30% of all hospitalisations in those with T1D were for ketoacidosis, most of which occurred more than three months after diabetes diagnosis, researchers say.

The figures were drawn from hospital records in Victoria and Queensland from 2010 to 2017, linked with patients aged under 20 with T1D on the National Diabetes Services Scheme.

All up, youth with T1D in the two states had 21,898 hospitalisations over the period examined, over 60% of which were directly related to diabetes, the study found.

In addition, they were greater than four times more likely to be hospitalised with infectious diseases diagnoses and three times more likely to be hospitalised for mental health and skin conditions than the general population.

Interestingly, patients with T1D were much more likely to be hospitalised with anogenital herpes viral infections and acute pancreatitis, although overall numbers were small in both cases, the researchers noted.

In the latter case, this mostly occurred in older teenagers (median age 17.1 years), suggesting the risk may be related to gallstone disease, they wrote in Diabetic Medicine (link here).

“Some of the increased risks of hospitalisation among youth with T1D may in part be explained by the fact that clinicians may have a lower threshold to admit those with T1D compared to those without diabetes for similar medical conditions of similar severity,” the researchers added.

The only exceptions to this rule of higher hospitalisations rate among patients with T1D were nonsuppurative otitis media (RR 0.31), chronic diseases of tonsils and adenoids (RR 0.66) and dental caries (RR 0.80), they added.

Hospitalisations for several respiratory conditions were also higher in the general population, although these findings were not statistically significant.

Some 47% of diabetes-related admissions were for ketoacidosis, the researchers found, based on an expanded dataset including NDSS T1D patients across Victoria, Queensland, NSW and the ACT from 2010 to 2019.

Concerningly, of those admitted for ketoacidosis, 26% were readmitted with the same diagnosis within 12 months, with even rates rates in patients living in disadvantaged areas, suggesting “many of these hospitalisations could be prevented by better community management,” the authors said.

“Our findings suggest that clinicians and policy makers should consider targeted management and resource allocation towards areas of highest socioeconomic disadvantage where youth with type 1 diabetes may be predisposed to ketoacidosis admission and readmission,” they added.

“Notably, the association between residence in areas of socioeconomic disadvantage and hospitalisation was stronger for hyperglycaemia than for hypoglycaemia. This may be in part due to the greater risk for poor outcomes among those residing in areas of highest socioeconomic disadvantage being partly offset by more aggressive glucose-lowering management among those residing in less disadvantaged areas.”

One fifth of diabetes-related admissions were for hyperglycaemia, almost all of which (92.5%) occurred more than three months after diagnosis. Almost one quarter of diabetes-related admissions (23.5%) were for uncomplicated diabetes, while 8.7% were for hypoglycaemia.

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