Hospital admissions for people with diagnosed diabetes: challenges for diabetes prevention and management programmes

Aim To identify the extent to which people with diabetes are admitted as inpatients to Counties Manukau District Health Board (CMDHB) hospitals compared to all New Zealand, and the costs of these admissions. Method Search of National Minimum Dataset for inpatient public hospital discharges with any mention of Type 1 or Type 2 diabetes from 1996-2007. Results Overall 13% of all CMDHB inpatient discharges mentioned diabetes in 2007 compared with 12% nationally. There were differences by ethnicity among those discharges aged 45 to 64 years, with Pacific (38%), Indian (31%) and Maori (31%) being more than three times as likely as European/Other people (10%) to experience a diabetes-recorded admission. There was a substantial increase in the rate of admission per 1000 where diabetes was recorded over 1996-2007, with Maori (31%) and Pacific (52%) people aged 45-64 years showing the largest increases. Findings from Counties Manukau tended to be comparable with total New Zealand data in terms of the percentage of people with diabetes who were inpatients in 2007, but relatively more inpatients in Counties Manukau had diabetes recorded (consistent with its high population of people with diabetes). Costs of admissions, laboratory investigations, and pharmaceuticals for people with diabetes were estimated to be $66 million per annum higher than for people without diabetes, in Counties Manukau alone. Conclusion The findings give support to balanced system-wide strategies (such as the Let's Beat Diabetes programme in Counties Manukau) that focus on both upstream (prevention) and downstream (management and coordinated care) responses to diabetes. The study points to a long-term and significant capacity challenge for secondary care services to respond to the forecast growth in the incidence of Type 2 diabetes, particularly in Counties Manukau. The findings also pose challenges for transfer of care to primary care providers after a hospital episode and the flow of information between care settings.