Diabetes: secondary care data

Hospital admissions data

Statistics on hospital admissions for diabetes are held in the Scottish Morbidity Record (SMR01) database. However, diabetes is often not recognised or recorded as the underlying reason for complications that lead to hospital admission. Anwar et al (2011) showed that admissions statistics underestimated the frequency of diabetes among hospital admissions in Scotland by around 41%.

Chart 1 shows the rate of hospital admissions where diabetes was the principal diagnosis and where it was one of the conditions mentioned (whether the principal diagnosis or not). After a sharp decrease from 2019/20 to 2020/21 in the rate of admissions where diabetes is the main diagnosis, there was an increase from 2020/21 to 2021/22. The sharp decrease from 2019/20 reflected the general decrease in the overall number of hospital admissions during the COVID-19 pandemic. The pandemic has caused significant changes to the provision of healthcare services, and has had an impact on individuals’ health and their use of healthcare services. Therefore, this data should be interpreted with caution.  As the impact of COVID-19 eased in the last year, we have seen an increase in the rate of admissions back towards pre-pandemic rates.

More information on trends in admissions is available from the Public Health Scotland website in the section on inpatient and day case activity diagnoses statistics.

Diabetic ketoacidosis

Diabetic ketoacidosis is a serious metabolic emergency that occurs principally in type 1 diabetes. The SMR01 database can be used to examine the numbers of hospital admissions with this condition. Chart 2 shows a steady rise in the rate of admissions of males in recent years, however, there has been an increase in 2021/22 across the majority of the groups. 

The coding of diabetic ketoacidosis is complex. In the internationally used ICD10 coding scheme ketoacidosis is coded using a "point 1" suffix after the code for diabetes type. The ".1" heading specifies diabetic ketoacidosis or acidosis without mention of coma. The inclusion of "acidosis" under this heading means that the figures above may include other forms of diabetic acidosis without coma, such as lactic acidosis. Further, the ".0" suffix includes diabetic coma (hyperglycaemic or hypoglycaemic) with or without ketoacidosis, so that the figures above exclude cases of ketoacidosis with coma.