People with diabetes treated with insulin have a 60% increased risk of serious injuries

According to a new study conducted by Australian researchers, people affected by diabetes treated with insulin have a 60% higher risk of being admitted to hospital for injuries, including head and neck trauma and burns, compared with the general population.

Lesions in patients with diabetes

According to the Baker Heart and Diabetes Institute, the elevated risk of injury in people with type 1 diabetes and those with insulin-treated type 2 diabetes may be attributed to the likelihood of hypoglycemic dips, when blood sugar levels drop dangerously low; and poorer vision and neuropathy, where reduced protective sensation means individuals don’t realize they’re being burned.

According to experts at the Baker Institute, fragility and loss of muscle strength in affected people are also worrying problems that deserve to be taken into consideration when talking about injuries.

The results, outlined in Diabetes Care and presented this week in Florida by Berhanu Feleke at the American Diabetes Association Scientific Sessions, provide critical information for people with diabetes, health care providers, and policy makers.

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

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

Drawing on data from programs and data sets from 2011 to 2017, the study examined more than 117,000 people with diabetes and more than 3.4 million people in the general population who were hospitalized due to an injury.

Among the study’s findings, the following was found:

•Falls account for 69% of injuries in affected people and 80% of head and neck injuries are attributed to falls.

•Among diabetics who suffered burns, 23% had neuropathy (a nerve disorder 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 T1D have a 60% increased risk of hospital admissions due to injury.

•Compared to the general population, the risk of hospitalization for any injury was 65% higher for people with T2D who used insulin, but was only 7% higher than in the general population among people with T2D who did not use insulin.

•Excess hospital admissions were higher among men with diabetes, reflecting a higher risk of injury among men.

Study author and diabetes specialist Professor Jonathan Shaw says hypoglycaemia is thought to contribute to the high rate of falls, along with peripheral neuropathy and reduced vision due to diabetic retinopathy.

Professor Shaw says that while many people may be aware that hypos can cause falls, they are not sufficiently aware that this carries a higher risk of serious injury. Similarly, it may not be widely known that almost one in four burns admissions was associated with neuropathy.

For example, it argues that people with type 1 diabetes are at greater risk of injury because they have lower bone mineral density than those without diabetes, while other studies have shown that they are six times more likely to suffer a hip fracture than the general population.

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

“We need to make people with diabetes, healthcare professionals and policy makers aware that muscle strength, frailty and neuropathy should be monitored, along with blood sugar management and poor vision,” says Professor Shaw.

“People with diabetes and on insulin therapy are at significantly higher risk of injury and this information should be used to raise awareness, plan prevention strategies, and provide appropriate support and resources.”

New discoveries on how diabetes affects bone health

In addition to causing blood sugar imbalances, type 1 diabetes can contribute to nerve damage and sensory abnormalities, a condition called neuropathy, and has been linked to a higher risk of bone fractures. A new study published in the Journal of Bone and Mineral Research examined the effects of type 1 diabetes and diabetic neuropathy on the skeleton.

Researchers have found that type 1 diabetes and diabetic neuropathy have various effects on bone structure, but these effects do not fully explain the higher risk of fractures in patients with type 1 diabetes.

The findings suggest that the increased risk of fractures in type 1 diabetes is multifactorial and involves both skeletal and non-skeletal features.

“It is important to investigate what leads to an increased risk of fractures in type 1 diabetes. Our findings suggest that in addition to bone characteristics, balance and muscle strength also play a role,” said lead author Tatiane Vilaca, MD, Ph.D., of the University of Sheffield, UK. “These findings could help improve approaches to fracture prevention.”

People with diabetes have a higher risk of bone fractures

People with diabetes are at increased risk of bone fractures, according to research from the University of Sheffield.

The research, conducted in collaboration with scientists at Sutter Health, concluded that people with type 1 and type 2 diabetes are at increased risk of suffering hip and nonvertebral fractures (those that do not occur in the spine or skull).

The findings, released during Diabetes Awareness Week (June 8-14, 2020), show that people with type 1 diabetes are at greater risk than people with type 2 diabetes; however, insulin use and length of living with the condition further increase the risk for people with type 2 diabetes.

Diabetes has many well-known complications, but this study highlights the impact of the disease on bone health, particularly fractures.

Lead researcher Dr Tatiane Vilaca, from the University of Sheffield’s Mellanby Centre for Bone Research, said: “Diabetes can cause a number of well-known complications, including kidney problems, vision loss, foot problems and nerve damage. However, until now many people with diabetes and their doctors were unaware that they were also at increased risk of bone fractures.

“We need to raise awareness of the increased risk people with diabetes face to help them prevent fractures. For example, preventing falls can reduce the risk of fractures.

“Fractures can be very serious, especially in older people. Hip fractures are the most serious because they cause a lot of disability. Around 76,000 people in the UK suffer a hip fracture each year and it is thought that up to 20 percent of people will die within a year of the fracture. Many others never regain full mobility and for many people it can cause a loss of independence.”

One in 15 people in the UK has diabetes, a serious condition in which the level of glucose in the blood is too high. There are two main types, type 1, when the body fails to produce insulin, and type 2, when the insulin the body produces fails to work effectively or not enough of it is produced.

Professor Richard Eastell, Professor of Bone Metabolism and Director of the Mellanby Centre for Bone Research at the University of Sheffield, said: “This important research highlights the urgent need for clinicians to assess fracture risk in patients with diabetes and also to look at potential treatments that may help reduce that risk.

“We hope that by raising awareness of the increased risks faced by people with diabetes, bone density and bone strength will become parameters that doctors routinely evaluate in patients with this disease, just as they currently do for other known complications.”

The research published online in Bone was conducted in collaboration with researchers from the School of Health and Related Research (ScHARR) at the University of Sheffield and the University of California.

Steven Cummings, MD, of Sutter Health, California, said: “Patients with diabetes and the physicians who care for them should be aware of the increased risk of fractures. Patients are encouraged to ask their physicians what to do about that risk, and physicians should assess the risk and consider treatment to reduce it.”