Studies have shown that people with diabetes treated with insulin have a 60% increased risk of serious injury

Diabetics treated with insulin have a more than 60% higher risk of hospitalisation for injuries, including head and neck injuries and burns, compared with the general population, according to a worrying new study by Australian researchers.

The Baker Heart and Diabetes Institute says the high risk of injury in people with type 1 diabetes and in people with type 2 diabetes treated with insulin may be due to the likelihood of hypoglycemic falls, when blood sugar levels drop dangerously low, as well as impaired vision and neuropathy, when reduced protective sensations make people unaware that they are getting burned.

Experts at the Baker Institute say muscle fragility and loss of strength in people with diabetes are also worrisome issues that need to be considered in the context of injury.

The results presented in Diabetes care and presented this week at the American Diabetes Association Scientific Sessions in Florida by Berhanu Feleke, provide important information for people with diabetes, health care professionals, and policymakers.

The study authors, led by Professors Jonathan Shaw and Dianna Magliano, call for intervention programmes to include strategies to prevent falls and develop muscle strength in people with insulin-related diabetes.

The study also serves as a powerful reminder of new and emerging complications of diabetes. While many people are aware of traditional complications of diabetes, such as eye, heart and kidney disease, this study reinforces the need to expand that focus to include emerging issues such as disability and frailty.

The study, which was based on data obtained from diabetes programs and data sets from 2011 to 2017, included more than 117,000 people with diabetes and more than 3.4 million people from the general population who were hospitalized due to injury.

The study found, among other things, that:

• Falls accounted for 69% of injuries in people with diabetes, and 80% of head and neck injuries were caused by falls.
• Twenty-three percent of diabetics who suffered burns had neuropathy (a disease of the nerves that can cause loss of sensation, pain, weakness or tingling in one or more parts of the body).
• Compared to the general population, people with type 1 diabetes have a 60% higher risk of hospitalization due to injury.
• Compared with the general population, the risk of hospital admission due to injury was 65% higher in people with type 2 diabetes using insulin, but only 7% higher than in the general population in people with type 2 diabetes not using insulin.
• Men with diabetes were more likely to require hospitalization, reflecting the greater risk of injury in these men.

Study author and diabetes specialist Professor Jonathan Shaw believes hypoglycaemia may be contributing to the high number of falls, while peripheral neuropathy and poorer eyesight caused by diabetic retinopathy may also play a role.

Professor Shaw says that while many people may be aware that “hypopathies” can lead to falls, it is not adequately appreciated that this leads to an increased risk of serious injury. Similarly, it may not be widely known that almost one in four burns hospitalisations is related to neuropathy.

He adds that people with type 1 diabetes are also at greater risk of injury because they have lower bone mineral density compared with people without diabetes, and other studies show they are six times more likely to suffer a hip fracture than the general population.

Another cause for concern is the fact that people with diabetes are 2 to 3 times more likely to develop sarcopenia, a disease characterized by a decrease in muscle mass and strength.

“We need people with diabetes, healthcare professionals and policymakers to realise that muscle strength, frailty and neuropathy should be on their radar, alongside blood glucose control and poor eyesight,” says Professor Shaw.

“People with diabetes who take insulin are at significantly increased risk of injury, and this information should be used to increase awareness, plan prevention strategies, and provide appropriate support and resources.”

Brought to you by Baker Heart and Diabetes Institute