The increased injury risk is known, but some of the associations are surprising.
Diabetic patients have an increased risk of injury-related hospitalisation – and taking insulin makes things worse.
Patients with diabetes are at an increased risk of injuring themselves as a result of hypoglycaemic complications, but there are little data quantifying this risk and the true burden of injury in this cohort.
New Australian research, published in Diabetes Care, shows diabetics have a 22% increase in the relative risk of being hospitalised for any kind of injury compared to the general population.
“[The findings] remind clinicians that diabetes is a multi-system chronic illness that embeds care needs across psychosocial, physical and metabolic domains, said Dr Gary Deed, chair of the RACGP’s diabetes specific interest group.
Researchers linked data from the Australian National Diabetes Service Scheme with hospitalisation records, the Pharmaceutical Benefits Scheme and the National Death index to explore the relative risk of excess injury-related hospitalisation in people with diabetes. Up to eight years of records for patients in Queensland and Victoria were examined as part of the study.
After controlling for age, sex and fiscal year, the adjusted risk of being hospitalised for any type of injury was 22% higher in the diabetic cohort compared to the rest of the population. This corresponds to an additional 550 hospitalisations each year per 100,000 people with diabetes.
When specific types of injury were considered, people with diabetes had a 52% increase in the relative risk of being hospitalised with a burn, a 29% increase for abdominal and thoracic injuries, a 28% increase for head and neck injuries, a 24% increase for lower limb injuries and a 37% increase for other unspecified types of injuries.
Related
The increased risk of hospitalisation compared to the general population was found in diabetic men and women, as well as in both type 1 and type 2 diabetics. The risk of injury-related hospitalisation was greater in people with type 2 diabetes using insulin (65% higher risk compared to the general population, while patients not using insulin only had a 7% higher risk).
Dr Deed was intrigued by the increased risk of injury in insulin users compared to non-users, questioning whether the greater risk was associated with the therapy itself, or whether it was associated with greater disease severity that required the use of insulin.
Falls were the most common cause of injury for head, lower extremity, upper extremity and abdominal and thoracic injury admissions (over 60% in each category).
“Falls in individuals with diabetes may stem from complications associated with diabetes, such as hypoglycaemia, peripheral neuropathy and poorer eyesight from peripheral neuropathy,” the researchers wrote.
Dr Deed noted the authors also speculated that sarcopenia could contribute to the potential falls risk.
Both the researchers and Dr Deed suggested integrating falls risk assessment and prevention strategies into annual care cycles for diabetes patients.
Caution must be taken when extrapolating the findings to the rest of the Australian population, as only data from Victoria and Queensland were included in the study. Dr Deed told TMR that it would have been nice to see whether and how the excess injury risk varied specifically according to patient age.
