Study shows: One in five hospital patients has diabetes

30.04.2021 12:40

A study led by Ulm University shows that almost one in five inpatients in Germany suffers from diabetes. The result not only reflects the care needs of diabetes patients in the hospital, but also reveals discrepancies with the previously published statistics on the number of cases of patients with diabetes in the hospital. Many diabetes patients have not yet been recorded if only patients with a main diagnosis of diabetes are counted. The Epidemiology and Health Care Research Commission of the German Diabetes Society (DDG) sees the study as evidence that the real numbers are significantly higher if patients with a secondary diagnosis of diabetes are taken into account.

In cases of COVID-19 in hospital, main and secondary diagnoses are usually considered, as in both cases the inpatient effort is significantly greater. The same thing should be done with diabetes, as people with a secondary diagnosis of diabetes also need additional, specialized and complex care in the hospital.

Almost every fifth hospital patient suffers from diabetes, shows the results of a study by the University of Ulm, which looks at the number of hospitalized diabetes cases between 2015 and 2017. The number refers to all hospital cases from the age of 20. “So far there has been no comprehensive data on the topic. Our study showed that in these three years, more than 18 percent of the approximately 16.5 million hospitalized cases had a primary or secondary diagnosis of diabetes,” explains study author Marie Auzanneau, MPH. “We also analyzed the frequency of the different types of diabetes.” Of the total of around 3.1 million hospital cases with diabetes in 2017, more than 2.8 million suffered from type 2 diabetes mellitus, according to the study, which will be published soon .

“It was striking that the length of stay and mortality among hospital cases with diabetes were higher than among those without diabetes,” explains Professor Dr. med Reinhard W. Holl. It has also been shown that the prevalence of diabetes was twice as high as in the general population. “This proves the high diabetes-associated mortality and highlights the significant inpatient care needs of increasingly older multimorbid diabetes patients,” explains Holl.

Secondary diagnosis of diabetes: effects greatly underestimated

It is also underestimated that diabetes, along with heart failure or atrial fibrillation, is one of the most common secondary diagnoses in hospitalized patients. This is shown by the DRG statistics from 2016, an annual full survey of all fully inpatient hospital cases within Germany that are billed according to flat rates. “In many statistics published so far on the subject, only the main diagnosis of diabetes is listed, but that does not reflect the real picture,” explains Professor Dr. med. Andreas Fritsche, spokesman for the Epidemiology and Health Services Research Commission of the DDG.

“The total number of inpatient diabetes patients is significantly underestimated because patients with a secondary diagnosis of diabetes are often not included in the published data. The current Ulm study shows that the real number of inpatient diabetes patients is 15 times higher than in some publications on hospitalized diabetes patients in Germany. However, their care in the hospital is just as complex; they need qualified therapy just like patients with the main diagnosis of diabetes,” says Fritsche.

Analogous reporting for secondary diagnosis of COVID and secondary diagnosis of diabetes

The example of the number of COVID cases shows how different the recording and reporting procedures are, says the diabetologist. The Robert Koch Institute (RKI) records every hospitalized patient who tests positive in the PCR test as a COVID case, although a significant proportion of these patients were admitted to hospital because of a different main diagnosis. The question arises as to why the same is not done for diabetes patients. “So far, the RKI has only reported on inpatient diabetes numbers for patients with a main diagnosis - but this results in a one-sided picture. “I therefore ask the RKI to carry out reporting according to the same criteria in order to record the actual burden on hospitals caused by inpatient diabetes patients,” says the diabetologist.

Link to the publication's post: https://pubmed.ncbi.nlm.nih.gov/33678220/. Dtsch Ärztebl Int. 2021 Jun 18;118(Forthcoming): arztebl.m2021.0151. doi: 10.3238/arztebl.m2021.0151. Online ahead of print.