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 not always 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%.

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 since 2023, we have seen an increase in the rate of admissions back towards pre-pandemic rates.

Chart 1 shows the rate of hospital admissions where type 1 diabetes was the principal diagnosis and where it was one of the conditions mentioned (’any diagnosis’).

Looking first at ‘any diagnosis’, the overall admissions rate has decreased from 205.1 per 100,000 in 2011/12 to 197.1 in 2023/24. Rates were consistently highest for males at 211.8 per 100,000 in 2023/24 compared to 183.7 per 100,000 for females.

Where type 1 diabetes was the principal diagnosis, rates have fluctuated between 2011/12 and 2023/24, increasing overall from 62.2 per 100,000 in 2011/12 to 65.8 in 2023/24. This was driven mainly by an increase in hospital admissions for males, which rose from 61.5 per 100,000 in 2011/12 to 69.6 in 2023/24, where rates for females remained similar at 62.8 in 2011/12, decreasing slightly to 62.2 in 2023/24.

Chart 2 shows the rate of hospital admissions where type 2 diabetes was the principal diagnosis and where it was one of the conditions mentioned (’any diagnosis’).

Hospital admissions for type 2 ‘any diagnosis’ are higher than for type 1, and have also increased between 2011/12 and 2023/24, seeing the same reduction during the height of the coronavirus pandemic. As with type 1, rates have been consistently higher for males (1418.8 per 100,000 in 2023/24) compared to females (947.2 per 100,000).

Admissions where type 2 diabetes was the principal diagnosis were lower overall than for type 1 but have increased over time from 35.2 in 2011/12 to 45.5 per 100,000 in 2023/24. The increases have been driven by admission for males with steep increases recorded between 2022/23 (51.0 per 100,000) and 2023/24 (61.2 per 100,00). For females, in the same period, rates rose from 27.6 to 31.5 per 100,000.

Diabetic ketoacidosis

Diabetic ketoacidosis is a metabolic emergency that occurs in both type 1 and type 2 diabetes. It occurs when ketones build up in the blood due to a lack of insulin. Diabetic ketoacidosis is potentially fatal but treatable with prompt medical attention. Rates have increased since 2021/22 for most age groups.  

The SMR01 database can be used to examine the numbers of hospital admissions with a main admission with this condition. Chart 3 shows recent increases in the rate of admissions of females and males with type 1 diabetes in most age groups in recent years. Rates were highest overall for males aged 25-44 and females aged 0-24. For males and females, rates were highest in the younger age groups (0-24 and 24-44). The overall age-sex standardised rate for all ages was 62.2 per 100,000 for females and 69.6 per 100,000 for males.

The figures calculated using this coding lacks precision since it both overestimates cases of ketoacidosis by including other types of acidosis and underestimates cases by excluding those where coma is present.

Males aged 65+ have the highest rate of admission for diabetic ketoacidosis – this is also higher than in type 1 diabetes groups. This figure has been increasing, rising from 121.2 per 100,000 in 2020/21 to 166.4 in 2023/24. Rates have been increasing across all age groups for males and females with type 2 diabetes, although rates are low in the 0-24 age group given the lower prevalence of type 2 diabetes in this age group. Between 2022/23 rates have increased from 57.2 per 100,000 to 62.2 for females, and from 67.6 per 100,000 to 69.6 for males.