Excess burden of hospitalizations in adults with diabetes - a national US cross-sectional study

The true burden of diabetes is likely underestimated by not considering the full range of complications associated with diabetes. Our aim was to compare cause-specific hospitalizations in adults with vs. without diabetes.

Our denominator included all adults with and without self-reported diabetes from the 2019 Behavioral Risk Factor Surveillance System Survey, weighted to reflect the U.S.

Our numerator, age-standardized risks of ICD-10-CM-defined inpatient hospitalizations and emergency department (ED) visits, were identified from the 2019 National Inpatient Sample and National ED Sample, respectively, weighted to be representative of U.S. hospitalizations. Each cause-specific hospitalization was classified as traditional, emerging, or other.

For inpatient hospitalizations, the highest absolute risk difference per classification was for sepsis (traditional; 1,680 [95%CI: 1,649-1,712] hospitalizations per 100,000), pneumonia (emerging; 225 [218-232]), and respiratory failure (other; 280 [272-289]). For ED visits, the highest absolute risk difference was for abscess, furuncle, and carbuncle (traditional; 388 [352-423] visits per 100,000), complications of cardiac devices (emerging; 111 [104-118]), and disorders of the urinary system (other; 299 [252-346]).

The causes of excess hospitalizations associated with diabetes extend well beyond traditional complications with implications for population-level planning, resource allocation, and individual diabetes management.