Emergency hospital admissions for patients with diabetes are increasing more quickly in deprived areas of England, a study of GP data has found.
The longitudinal study, published in the British Journal of General Practice, was assessing the impact of NHS efforts to reduce inequalities in diabetes outcomes.
The researchers analysed QOF performance data on HbA1c thresholds, data on emergency admissions due to preventable diabetes complications and deaths from diabetes related to causes considered amenable to healthcare across over 32,000 English neighbourhoods.
Comparing the results from 2004/05 with 2011/12 in the most deprived and wealthiest quintiles of neighbourhoods, the researchers found that:
- Emergency hospital admissions for diabetes increased by a mean rate of 59.84 admissions per 100 000 population in all social groups;
- The increase was faster in the most deprived neighbourhood, with socioeconomic inequality associated with an excess of 16,199 admissions.
- The largest increase in numbers of admissions from 2004/05 to 2011/12 was for hypoglycaemia, rising from 7,476 to 11,564. Admissions due to ketoacidosis in people with type-2 diabetes also increased considerably, from 1,342 to 2,278.
But there were also positive findings, as glycaemic control improved in all social groups regardless of deprivation level across the study period, and diabetes-related amenable mortality also decreased in all social groups, but more quickly in the most deprived neighbourhoods. The researchers estimated that there were around 600 fewer deaths linked to reduced health inequalities.
The study authors, from the University of East Anglia in Norwich, said that the fall in mortality was ‘a remarkable achievement’, especially given that ‘diabetes prevalence is rising and the targeting of NHS resources often does not promote health equity’.
But they added: ‘In contrast, the growth in emergency admissions for diabetes is worrying. Emergency hospitalisation grew faster in more deprived neighbourhoods.’
The researchers said the finding may be explained by factors including increased prevalence, improved detection and longer lifespans, but warned that it could also be to do with overuse of glycaemic control drugs.
They recommend that GPs follow NICE guidance for patients with hypoglycaemia and ensure that they have individualised HbA1c targets.