Trends in incidence of hospitalization for hypoglycemia and diabetic ketoacidosis in individuals with type 1 or type 2 diabetes with and without severe mental illness, in Denmark from 1996-2020: A nationwide study

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posted on 2024-04-19, 16:02 authored by Stine H. Scheuer, Gregers S. Andersen, Bendix Carstensen, Lars Diaz, Vanja Kosjerina, Nanna Lindekilde, Sarah H. Wild, Caroline A. Jackson, Frans Pouwer, Michael E. Benros, Marit E. Jørgensen

OBJECTIVE

To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year.

RESEARCH DESIGN AND METHODS

We conducted a cohort study using nationwide registers from 1996-2020 to identify individuals with diabetes, ascertain SMI status (schizophrenia, bipolar disorder, or major depression) and identify the outcomes, hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, calendar year, accounting for sex, diabetes duration, education, and country of origin.

RESULTS

Amongst 433,609 individuals with diabetes, 9% had SMI. Risk of (first and subsequent) hypoglycemia events was higher in individuals with SMI versus without SMI (IRR for first hypoglycemia event: type 1 diabetes: 1.77 [95% CI, 1.56-2.00], type 2 diabetes: 1.64 [95% CI, 1.56-1.74]). Individuals with schizophrenia were particularly at risk of recurrent hypoglycemia events. Risk of first DKA event was higher in individuals with SMI (IRR of first DKA event: type 1 diabetes: 1.78 [95% CI. 1.50-2.11], type 2 diabetes: 1.85 [95% CI. 1.64-2.09]). Except for DKA in the type 2 diabetes group, incidence rate differences between individuals with and without SMI were highest in younger individuals (<50 years) but stable across calendar year.

CONCLUSIONS

SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.