Inpatient care of patients with type 1 diabetes mellitus by duration of diabetes and sex: A nationwide population-based longitudinal study

Original Research

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Authors: Markku J Akkanen, Sirkka-Liisa Kivelä, Veli Koistinen, et al.

Published Date July 2009 Volume 2009:2 Pages 55 - 64

DOI: http://dx.doi.org/10.2147/RMHP.S5262

Markku J Akkanen^1,4, Sirkka-Liisa Kivelä², Veli Koistinen³, Harri Sintonen⁴, Jaakko Tuomilehto⁴

¹Welfare and Health Promotion Division, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland; ²Turku University of Central Hospital, Turku, Finland; ³Department of Health Policy and Management, University of Kuopio, Kuopio, Finland; ⁴Department of Public Health, University of Helsinki, Helsinki, Finland

Aims: To describe hospitalizations of a cohort of patients with type 1 diabetes mellitus (T1DM) during 1973–1998 in the main complication groups by sex and T1DM lasting on average 9.5 or 16.5 years.

Material and methods: The population (N = 5166) consisted of all Finnish patients with T1DM diagnosed before the age of 18 years between 1965–1979, derived from the Finnish population-based register of T1DM patients. Data on hospitalizations were obtained from the Finnish Hospital Discharge Register.

Results: In the early stages of T1DM, the majority of the use of hospitalizations was due to the treatment of T1DM without complications. Enormous increases were found for complications when diabetes lasted longer (from 9.5 to 16.5 years). For women, the yearly number of bed-days for renal complications increased 4.8-fold, for peripheral vascular disease 4.3-fold, and for ophthalmic complications 2.5-fold. For men, the corresponding increases were as follows: 5-fold, 6.9-fold, and 2.5-fold. The yearly number of bed-days for nephropathy increased 7-fold. Bed-days for T1DM without complications dropped dramatically. The length of stay in hospitalizations decreased notably, but hospital visits increased when the duration of T1DM increased.

Conclusions: Hospitalizations due to complications substantially increase with aging of T1DM patients. Prevention of T1DM is strongly needed.

Keywords: T1DM, inpatient care, hospitalizations, complications

General overview: Diabetes has major long-term implications, not only for the health and well-being of individuals, but also for health service costs. Diabetes may cause many complications, such as retinopathy, nephropathy, cardiac and cerebrovascular disease, and peripheral vascular disease with neuropathy, and the propability of developing these is related to the duration of diabetes and metabolic control. The majority of hospitalizations in Finland was due to the treatment of early-stage T1DM without complications. Enormous increases were found for complications when diabetes lasted longer (from 9.5 to 16.5 years). For women, the yearly number of bed-days for renal complications increased 4.8-fold, for peripheral vascular disease 4.3-fold, and for ophthalmic complications 2.5-fold. For men, the corresponding increases were as follows: 5-fold, 6.9-fold, and 2.5-fold, respectively. The yearly bed-days for nephropathy 7-folded. Bed-days for T1DM without complications dropped dramatically. The length of stay in hospitalizations decreased notably, but hospital visits increased, when the duration of T1DM increased. In conclusion, hospitalizations due to complications substantially increased with aging of T1DM patients.