Preadmission insulin-treated diabetes patients more likely to die in ICUs: Study
China: Among type 2 diabetes (T2DM) patients in ICU, preadmission insulin treatment is associated with a longer length of ICU stay and an increased mortality rate, a recent study has stated.
The results of the study, published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, indicate that when critically ill, preadmission insulin-treated T2DM patients might have worse clinical outcomes. This implies that in ICU, clinicians should be more concerned about preadmission insulin-treated T2DM patients.
Rongping Fan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China, and colleagues aimed to explore the clinical outcomes among preadmission insulin-treated type 2 diabetes mellitus in intensive care units (ICU) in a retrospective observational study.
For this purpose, the researchers recruited 578 T2DM patients admitted to ICU from March 2011 to February 2021. It was composed of 528 patients treated with insulin after ICU admission (including 300 preadmission non-insulin-treated and 228 preadmission insulin-treated patients) and 50 patients treated without insulin before and after ICU admission. A comparison of clinical outcomes was done between the groups. To get the 1:1 matched cohort, variables of age (± 10 years), gender, blood glucose > 10 mmol/l on ICU admission, and original comorbidities were used. To describe the survival trend, the Kaplan–Meier survival curves were graphed and Cox regression analysis was performed to get an adjusted hazard ratio (HR).
The researchers reported the following findings:
- Compared with the preadmission non-insulin-treated T2DM patients, preadmission insulin-treated T2DM patients had a higher incidence of hypoglycemia [14.5% (33/228) vs 8.7% (26/300)].
- In the 1:1 matched cohort, the preadmission insulin-treated T2DM patients had significantly increased mortality rate [30.0% (45/150) vs (16.0% (24/150)); adjusted HR, 1.68] than preadmission non-insulin-treated T2DM patients.
- Compared with T2DM patients treated without insulin before and after ICU admission, preadmission insulin-treated T2DM patients had higher mortality and longer length of ICU stay.
The researchers wrote, "the history of preadmission insulin treatment may be a marker of poor prognosis for T2DM patients with critically ill states and may help clinicians identify patients who need more aggressive treatments to prevent poor clinical outcomes."
Reference:
Fan R, Xie L, Peng X, Yu B, Zou H, Huang J, Yu X, Wang D, Yang Y. Preadmission Insulin-Treated Type 2 Diabetes Mellitus Patients Had Increased Mortality in Intensive Care Units. Diabetes Metab Syndr Obes. 2022;15:2135-2148
https://doi.org/10.2147/DMSO.S369152
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