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Risk of type 2 diabetes mellitus in patients with acute critical illness: a population-based cohort study

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Abstract

Purpose

This large population-based cohort study evaluated the association between certain critical illnesses and the incidence of newly diagnosed type 2 diabetes mellitus (T2DM) in Taiwan.

Methods

Data were obtained from the Taiwan National Health Insurance Research Database. According to age, sex, and propensity score-matching, a cohort comprising 9528 patients with critical illness, including septicemia, septic shock, acute myocardial infarction (AMI), and stroke, and a control cohort of 9528 patients with no critical illness were identified. Cox proportional-hazard regression and competing-risk regression models were employed to evaluate the risk of developing T2DM.

Findings

With the median follow-up periods (interquartile range) of 3.86 (1.64–6.93) and 5.12 (2.51–8.13) years for the patients in the critical illness and control cohorts, respectively, the risk of developing T2DM in the critical illness cohort was significantly higher than in the control cohort (adjusted hazard ratio, aHR = 1.32; 95 % confidence interval, CI 1.16–1.50). In the multivariate competing-risk regression models, the aHR of T2DM was 1.58 (95 % CI 1.45–1.72) in the critical illness cohort. Moreover, among the patients with these critical illnesses, those with septicemia or septic shock exhibited the highest risk of developing T2DM (aHR = 1.51, 95 % CI 1.37–1.67), followed by AMI compared with the control cohort.

Conclusion

Our results suggest that patients with certain critical illnesses are associated with a high risk of developing T2DM. Clinicians should be aware of this association and intensively screen for T2DM in patients following diagnosis of critical illness.

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Acknowledgments

Hsu CW was supported by Taipei Medical University (TMU 102-AE1-B07) and Wan Fang Hospital, Taipei Medical University (104-wf-eva-13). Lin CS was supported by grants from Tri-Service General Hospital (TSGH-C104-026) and the Taiwan Ministry of Science and Technology (MOST 103-2628-B-016-002-MY3). Kao CH was supported by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002); China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092); NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.

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    Authors and Affiliations

    1. Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

      Chin-Wang Hsu

    2. Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

      Chin-Wang Hsu

    3. Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

      Chin-Sheng Lin

    4. Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

      Sy-Jou Chen

    5. Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

      Shih-Hua Lin

    6. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

      Cheng-Li Lin

    7. College of Medicine, China Medical University, Taichung, Taiwan

      Cheng-Li Lin

    8. Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

      Chia-Hung Kao

    9. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

      Chia-Hung Kao

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    1. Chin-Wang Hsu
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    2. Chin-Sheng Lin
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    Correspondence to Chia-Hung Kao.

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    Additional information

    C.-S. Lin and C.-H. Kao are equal contributors.

    Take-home message: Our results suggest that patients with critical illness are associated with a high risk of T2DM. Clinicians should be aware of this association and screen carefully for T2DM in patients following diagnosis of critical illness.

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    Hsu, CW., Lin, CS., Chen, SJ. et al. Risk of type 2 diabetes mellitus in patients with acute critical illness: a population-based cohort study. Intensive Care Med 42, 38–45 (2016). https://doi.org/10.1007/s00134-015-4044-2

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    • DOI: https://doi.org/10.1007/s00134-015-4044-2

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