Abstract
Introduction: Insulin treatment was associated with enhanced systemic inflammation that may lead to adverse clinical outcomes of critical illness, but clinical data are limited. We examined the impact of pre-admission insulin use on in-hospital mortality among critically ill patients with type 2 diabetes (T2D). Methods: This retrospective study investigated 372 critically ill patients with T2D from 3500 cases admitted to an ICU between March 2011 and April 2020 at Tongji Hospital (Wuhan). Clinical characteristics and outcomes were compared among those treated with or without insulin before admission. Results: Among the 372 critically ill patients with T2D, 249(59%) had pre-admission insulin prescriptions for > 3 months. A total of 246 patients were 1:1 matched by age and diabetic complications, among whom the median age was 62 (IQR, 54.0-70.0) years, and 155(63.0% ) were male and 91(37.0%) were female. Compared with critically ill patients with T2D treated without insulin before admission, patients with pre-admission insulin treatment had increased in-hospital mortality(22.8%(28/123)vs.(12.2%(15/123); P=0.029) and longer length of ICU stay(6(4~10)vs. 5(3~8); P=0.025). Logistic regression analysis showed that pre-admission insulin treatment was associated with a 2.122-fold higher risk for mortality in critically ill patients with T2D (OR=2.122, 95% CI (1.07-4.21) P=0.031), and the risk was higher after adjustment for age, gender, chronic kidney disease, hemoglobin, creatinine, eGFR, CRRT (OR=2.487, 95% CI (1.190-5.197) P=0.015). Conclusions: Pre-admission insulin treatment might be associated with increased in-hospital mortality and longer length of ICU stay among critically ill patients with T2D. This association warrants further investigation. Disclosure R. Fan: None.
Published Version
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