Abstract
We aimed to assess national trends in the rates of diabetes-related potentially preventable hospitalizations (overall and by preventable condition) in the total adult population of Spain. We performed a population-based study of all adult patients with diabetes who were hospitalized from 1997 to 2015. Overall potentially preventable hospitalizations and hospitalizations by diabetes-related preventable conditions (short-term complications, long-term complications, uncontrolled diabetes, and lower-extremity amputations) were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. Over 19-years-period, 424,874 diabetes-related potentially preventable hospitalizations were recorded. Overall diabetes-related potentially preventable hospitalizations decreased significantly, with an average annual percentage change of 5.1 (95%CI: −5.6–(−4.7%); ptrend < 0.001). Among preventable conditions, the greatest decrease was observed in uncontrolled diabetes (−5.6%; 95%CI: −6.7–(−4.7%); ptrend < 0.001), followed by short-term complications (−5.4%; 95%CI: −6.1–(−4.9%); ptrend < 0.001), long-term complications (−4.6%; 95%CI: −5.1–(−3.9%); ptrend < 0.001), and lower-extremity amputations (−1.9%; 95%CI: −3.0–(−1.3%); ptrend < 0.001). These reductions were observed in all age strata for overall DM-related PPH and by preventable condition but lower-extremity amputations for those <65 years old. There was a greater reduction in overall DM-related PPH, uncontrolled DM, long-term-complications, and lower extremity amputations in females than in males (all p < 0.01). No significant difference was shown for short-term complications (p = 0.101). Our study shows a significant reduction in national trends for diabetes-related potentially preventable hospitalizations in Spain. These findings could suggest a sustained improvement in diabetes care in Spain, despite the burden of these diabetes-related complications and the increase in the diabetes mellitus prevalence.
Highlights
Patients with diabetes mellitus (DM) are at greater risk to be hospitalized
The greatest average annual decrease was observed in uncontrolled DM, followed by short-term complications, long-term complications, and lower-extremity amputations
There is a considerable interest in health care aspects of DM, epidemiological data of hospitalizations in patients with DM have been insufficiently described in many regions worldwide
Summary
Patients with diabetes mellitus (DM) are at greater risk to be hospitalized. A high proportion of these hospitalizations are due to DM complications both in patients with type-1 and type-2 DM [1,2]. Effective treatment, and appropriate education could improve the management of DM, prevent the development and worsening of DM-related complications, and reduce hospitalizations [5]. These DM-related potentially preventable hospitalizations (PPH) have been identified as a good indicator of the efficiency and quality of health system [6,7,8]. The Agency for Health Care Research and Quality (AHRQ) has identified four conditions of DM-related PPH: short-term DM complications, long-term DM complications, uncontrolled DM, and lower-extremity DM-related amputations [9]
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