OBJECTIVE To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56–2.00]; type 2 diabetes, 1.64 [95% CI 1.55–1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50–2.11]; type 2 diabetes, 1.85 [95% CI 1.64–2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.

中文翻译：

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1996 年至 2020 年丹麦患有或不患有严重精神疾病的 1 型或 2 型糖尿病患者因低血糖和糖尿病酮症酸中毒住院的发生率趋势：一项全国性研究

目的 按年龄和日历年研究丹麦患有或不患有严重精神疾病 (SMI) 的 1 型或 2 型糖尿病患者的急性糖尿病并发症发生率趋势。研究设计和方法我们利用 1996 年至 2020 年全国登记册进行了一项队列研究，以确定糖尿病患者、确定 SMI 状态（即精神分裂症、双相情感障碍或重度抑郁症）并确定结果：因低血糖和糖尿病酮症酸中毒 (DKA) 住院）。我们使用泊松回归根据 SMI、年龄和日历年份来估计复发性低血糖和 DKA 事件的发病率 (IR) 和发病率比 (IRR)，并考虑性别、糖尿病病程、教育程度和原籍国。结果 在 433,609 名糖尿病患者中，8% 患有 SMI。患有 SMI 的个体发生（首次和后续）低血糖事件的风险高于没有 SMI 的个体（首次低血糖事件 IRR：1 型糖尿病，1.77 [95% CI 1.56–2.00]；2 型糖尿病，1.64 [95% CI 1.55–1.74]）。精神分裂症患者特别容易发生反复低血糖事件。患有 SMI 的个体首次 DKA 事件的风险较高（对于首次 DKA 事件，IRR：1 型糖尿病，1.78 [95% CI 1.50–2.11]；2 型糖尿病，1.85 [95% CI 1.64–2.09]）。除 2 型糖尿病组中的 DKA 外，患有和不患有 SMI 的个体之间的 IR 差异在年轻个体（<50 岁）中最高，但在整个日历年中保持稳定。结论 SMI是糖尿病急性并发症的重要危险因素，该人群需要有效预防，特别是年轻人群和精神分裂症患者。