Preadmission Insulin-Treated Type 2 Diabetes Mellitus Patients Had Increased Mortality in Intensive Care Units

Rongping Fan; Lei Xie; Xuemin Peng; Bo Yu; Huajie Zou; Jiaojiao Huang; Xuefeng Yu; Daowen Wang; Yan Yang

doi:10.2147/DMSO.S369152

Preadmission Insulin-Treated Type 2 Diabetes Mellitus Patients Had Increased Mortality in Intensive Care Units

Diabetes Metab Syndr Obes. 2022 Jul 22:15:2135-2148. doi: 10.2147/DMSO.S369152. eCollection 2022.

Authors

Rongping Fan^#^{1

2}, Lei Xie^#^{1

2}, Xuemin Peng^{1

2}, Bo Yu³, Huajie Zou^{1

2

4}, Jiaojiao Huang^{1

2}, Xuefeng Yu^{1

2}, Daowen Wang³, Yan Yang^{1

2}

Affiliations

¹ Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
² Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People's Republic of China.
³ Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
⁴ Division of Endocrinology, Department of Internal Medicine, The Affiliated Hospital of Qinghai University, Xining, Qinghai, 810001, People's Republic of China.

^# Contributed equally.

Abstract

Aim: To explore the clinical outcomes among preadmission insulin-treated type 2 diabetes mellitus (T2DM) in intensive care units (ICU).

Patients and methods: In this retrospective observational study, 578 T2DM patients admitted to ICU were recruited from March 2011 to February 2021, which were 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. Clinical outcomes were compared between the groups. Variables of age (± 10 years), gender, blood glucose >10 mmol/l on ICU admission, and original comorbidities were used for matching to get the 1:1 matched cohort. The Kaplan-Meier survival curves were graphed to describe the survival trend and Cox regression analysis was performed to get adjusted hazard ratio (HR).

Results: Compared with the preadmission non-insulin-treated T2DM patients, preadmission insulin-treated T2DM patients had higher incidence of hypoglycemia [14.5% (33/228) vs 8.7% (26/300); p = 0.036]. 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 (1.01-2.80)] 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 (all p < 0.05).

Conclusion: Preadmission insulin treatment was associated with increased mortality rate and longer length of ICU stay among T2DM patients in ICU. Preadmission insulin-treated T2DM patients might have worse clinical outcomes when they are critically ill.

Keywords: ICU stay; insulin treatment; intensive care units; mortality; type 2 diabetes mellitus.

Grants and funding

This work was supported by projects from the National Nature Science Foundation of China (grant numbers 81670754, 81974114, 81630010, 81790624, C-0052), Ministry of Science and Technology of China (grant number 2020YFC0844500), Major Projects of the Technological Innovation of Hubei province (grant number 2017ACA170), and funds from the Jie Chu Jing Ying foundation (grant number 2018076).