Temporal trend in hospitalizations for acute diabetic complications: a nationwide study, Italy, 2001-2010

PLoS One. 2013 May 23;8(5):e63675. doi: 10.1371/journal.pone.0063675. Print 2013.


Background: We investigated temporal trends and geographic variations in both hospitalizations and in-hospital mortality rates for acute diabetic complications (ADC) in the Italian universal health care system.

Methods and findings: A retrospective review of the medical records of patients with either primary or secondary discharge diagnosis of hyperglycaemic acute complications (ICD-9-CM codes 250.1, 250.2, 250.3) or hypoglycemic coma (ICD-9-CM code 251.0) was performed in period 2001-2010. Standardized rates by age and gender on 2001 Italian population and by diabetic population were calculated. We identified 7,601.883 diabetes-related hospital discharges. Out of them, 266,374 (3.5%) were due to ADC, either ketoacidosis/hyperosmolarity (94.4%) or hypoglycemic coma (5.6%). The rate of discharge for ADC decreased by 51.1% from 2001 to 2010 (14.4 vs. 7.1 discharge rate/1,000 diabetic people; 5.7% decrease per year, test for trend, p<0.001) with a similar trend for both hyperglycemic and hypoglycemic complications. Diabetic people in the younger age groups (≤ 19 and 20-44 years old) had a significantly greater rate of discharge for ADC than people aged 65 years and over (≤ 19 10-fold increase; 20-44: 2-fold increase). In-hospital mortality rate was 7.6%, with 211 preventable deaths in younger diabetic people (≤ 44 years old). There was a large variability among Italian Regions and the ratio between the highest and the lowest regional discharge rate reached 300% in 2010.

Conclusions: Decreasing temporal trend in hospitalizations for preventable ADC suggests improving outpatient care. In younger diabetic patients, however, both hospitalization rates and in-hospital mortality are still a matter of concern.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Child
  • Child, Preschool
  • Diabetes Complications / epidemiology*
  • Diabetes Complications / therapy
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends*
  • Humans
  • Infant
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Young Adult

Grant support

This work was supported by the Piedmont Region, Diabetes Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.