Remark: data update pending through 2024, T2D
V.F. Lit, MSc1,2, S.A.G. de Vries, MD3, T.C.J. Sas, MD PhD4,5, D. Mul, MD PhD4, R.H.H. Groenwold, MD MSc PhD1, J.C.G. Bak, MD PhD6, T. van Bemmel, MD PhD7, A.C. van Bon, MD PhD 8, I. Eland, MD PhD9, E.H. Serné, MD PhD3, P. Stouthart, MD10, H.W. de Valk, MD PhD11, M.M.J.W. Wijers-van Amelsfort, MD12, M. Zwiers, MD13, M. Nieuwdorp, MD PhD3, M.W.J.M. Wouters, MD PhD1, C.L. Verheugt, MD MSc PhD1
1Leiden University Medical Centre, Leiden
2 Dutch Institute for Clinical Auditing, Leiden
Background
Type 1 diabetes mellitus (T1D) is a lifelong condition with complications that often require inpatient treatment. Hospitalization costs put perpetual pressure on healthcare systems. This study investigates rates, causes for and predictors of hospitalization in children and adults with T1D treated in hospitals.
Methods
Cohort study with five years of prospective follow-up (2017-2021) using the national Dutch Pediatric and Adult Registry of Diabetes (DPARD). Data were linked to the national hospital discharge register and Statistics Netherlands. All-cause and diabetes-specific hospitalization rates were determined. Cox proportional hazard regression was used to assess clinical determinants for all-cause and diabetes hospitalization in adults.
Results
Of 7,487 T1D patients, 2,444 were hospitalized at least once, with 6,821 hospitalizations during 28,255 person-years of follow-up (PY). Among all hospitalizations 16% were caused by acute diabetes complications (of which 41% due to ketoacidosis), and 11% by cardiovascular events.
Hospitalization rates were 24.1/100PY for all-cause and 4.0/100PY for diabetes hospitalization, with a decrease during the COVID-19 pandemic in 2020. Higher hospitalization rates were observed for females: all-cause 28.2/100PY (vs. 20.4/100PY among males) and diabetes hospitalization 4.5/100PY (vs. 3.5/100PY among males). Female sex, educational level, eGFR <60 ml/min, and HbA1c >64 mmol/mol (8,1%) were associated with all-cause and diabetes hospitalization. Additionally, older age was associated with all-cause hospitalization.
Conclusion
Hospitalization causes were diverse yet mainly cause by acute diabetes complications and cardiovascular disease. Differences in hospitalization risks were observed, sex and education among the associated factors. Current insights may help target clinical risk factors and subpopulations at risk for hospitalization.