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

Stine H Scheuer*, Gregers S Andersen, Bendix Carstensen, Lars J Diaz , Vanja Kosjerina, Nanna Lindekilde, Sarah H Wild, Caroline A Jackson, Frans Pouwer, Michael E Benros, Marit E Jørgensen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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.
Original languageEnglish
JournalDiabetes Care
Early online date19 Apr 2024
DOIs
Publication statusE-pub ahead of print - 19 Apr 2024

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