Diabetes: secondary care data

Hospital discharge data

Statistics on hospital discharges 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. Leslie et al showed that discharge statistics underestimate the importance of diabetes as a cause of hospital admission. Table 1 shows hospital discharges with diabetes for the calendar year 2008 for Scotland as a whole. Data on trends in admissions are available from the ISD Scotland website in the section on inpatient, day case and outpatient activity statistics under "diagnosis data". Users should note that the ISD statistics show numbers of people admitted to hospital with diabetes for the first time (incidence) while the figures below show the number of people admitted at least once during the year.

Table 1: Number of hospital discharges for diabetes (1) and number of people with at least one discharge during the year for diabetes, Scotland, calendar year 2008

	Female	Male	All
No of hospital discharges with:
. . diabetes as principal diagnosis	3,268	3,419	6,687
diabetes mentioned in any diagnostic position	38,633	43,884	82,517
No of people with at least one discharge with:
. . diabetes as principal diagnosis	1,810	2,049	3,859
diabetes mentioned in any diagnostic position	17,724	19,552	37,276

(1) Using diagnostic codes ICD10 E10-E14 and based on the number of episodes of care.
Source: SMR01 (ISD Scotland) IR2009-02891.

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 discharges with this condition. Table 2 shows a rise in the number of discharges over the last five years. The rise is relatively larger among men than women. Although the number of discharges is smaller among older age groups, the relative rise in discharges has been larger. The increase in discharges with diabetic ketoacidosis parallels the rise in numbers of cases of diabetes recorded by the Scottish Diabetes Survey between 2003 and 2007. The coding of diabetic ketoacidosis is complex, and users of these data should read the note below the table.

Table 2. Number of hospital discharges with a principal diagnosis of diabetic ketoacidosis, by financial year, age group and sex, Scotland, 2003/04 to 2007/08; percentage change in number of admissions between 2003/04 and 2007/08 (1).

	2003/04	2004/05	2005/06	2006/07	2007/08	% change
Persons
All ages	1479	1526	1565	1855	1974	33
0-24 years	701	676	732	851	912	30
25-44 years	449	452	468	573	581	29
45-64 years	218	270	261	290	320	47
65 years and above	111	128	104	141	161	45
Males
All ages	712	735	773	941	1018	43
0-24 years	318	321	344	406	440	38
25-44 years	240	227	229	310	331	38
45-64 years	107	137	159	172	176	64
65 years and above	47	50	41	53	71	51
Females
All ages	767	791	792	914	956	25
0-24 years	383	355	388	445	472	23
25-44 years	209	225	239	263	250	20
45-64 years	111	133	102	118	144	30
65 years and above	64	78	63	88	90	41

(1) Figures are for both sexes combined and are based on discharges with ICD 10 codes E10.1, E11.1, E12.1, E13.1 and E14.1 in the main diagnostic position. Source: ISD SMR01, IR2009_01010.

Note on coding

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.