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Insulin-dependent diabetes and serious trauma

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Trauma patients with diabetes mellitus (DM) represent a unique population as the acute injury and the underlying disease may both cause hyperglycemia that leads to poor outcomes. We investigated how insulin-dependent DM (IDDM) and noninsulin-dependent DM (NIDDM) impact mortality after serious trauma without brain injury.

Methods

The National Trauma Data Bank (NTDB) version 7.0 was queried for all patients with moderate to severe traumatic injury [injury severity score (ISS) >9]. Patients were excluded if missing data, age <10 years, severe brain injury [head abbreviated injury scale (AIS) >3], dead on arrival or any AIS = 6. Logistic regression modeled the association between DM and mortality as well as IDDM, NIDDM and mortality.

Results

Overall 166,103 trauma patients without brain injury were analyzed. Mortality was 7.6 and 4.4 % in patients with and without DM, respectively (p < 0.01). Mortality was 9.9 % for patients with IDDM and 6.7 % for NIDDM (p < 0.01). The increased mortality associated with DM was only significantly higher for DM patients in their forties (5.6 vs. 3.3 %, p < 0.01). Regression analyses demonstrated that DM (AOR 1.14, p = 0.04) and IDDM (AOR 1.46, p < 0.01) were predictors of mortality compared to no DM, but NIDDM was not (AOR 1.02, p = 0.83).

Conclusions

While DM was a predictor for higher mortality after serious trauma, this increase was only observed in IDDM and not NIDDM. Our findings suggest IDDM patients who present after serious trauma are unique and attention to their hyperglycemia and related insulin therapy may play a critical role in recovery.

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Authors and Affiliations

  1. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    D. Z. Liou, M. B. Singer, G. Barmparas, M. Y. Harada, J. Mirocha & E. J. Ley

  2. Department of Trauma and Critical Care, Delray Medical Center, Delray Beach, FL, USA

    M. Bukur

  3. Broward General Medical Center, Fort Lauderdale, FL, USA

    M. Bukur

  4. Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    A. Salim

Authors
  1. D. Z. Liou
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  2. M. B. Singer
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  3. G. Barmparas
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  4. M. Y. Harada
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  5. J. Mirocha
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  6. M. Bukur
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  7. A. Salim
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  8. E. J. Ley
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Corresponding author

Correspondence to G. Barmparas.

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Conflict of interest

Authors Douglas Z Liou, Matthew B Singer, Galinos Barmparas, Megan Y Harada, James Mirocha, Marko Bukur, Ali Salim, and Eric J Ley declare that they have no conflict of interest.

Ethical standard

A database of de-identified patient information was used to conduct this study. This article does not contain any studies with human or animal subjects. The study was approved by the institutional review board at Cedars-Sinai Medical Center.

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Liou, D.Z., Singer, M.B., Barmparas, G. et al. Insulin-dependent diabetes and serious trauma. Eur J Trauma Emerg Surg 42, 491–496 (2016). https://doi.org/10.1007/s00068-015-0561-5

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  • DOI: https://doi.org/10.1007/s00068-015-0561-5

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