Diabetes mellitus after injury in burn and non-burned patients: A population based retrospective cohort study

Abstract

ObjectiveTo compare hospitalisations for diabetes mellitus (DM) after injury experienced by burn patients, non-burn trauma patients and people with no record of injury admission, adjusting for socio-demographic, health and injury factors. MethodsLinked hospital and death data for a burn patient cohort (n=30,997) in Western Australia during the period 1980–2012 and two age and gender frequency matched comparison cohorts: non-burn trauma patients (n=28,647); non-injured people (n=123,399). The number of DM admissions and length of stay were used as outcome measures. Multivariate negative binomial regression was used to derive adjusted incidence rate ratios and 95% confidence intervals (IRR, 95%CI) for overall post-injury DM admission rates. Multivariate Cox regression models and hazard ratios (HR) were used to examine time to first DM admission and incident admission rates after injury discharge. ResultsThe burn cohort (IRR, 95%: 2.21, 1.80–2.72) and other non-burn trauma cohort (IRR, 95%CI: 1.63, 1.24–2.14) experienced significantly higher post-discharge admission rates for DM than non-injured people. Compared with the non-burn trauma cohort, the burn cohort experienced a higher rate of post-discharge DM admissions (IRR, 95%CI: 1.40, 1.07–1.84). First-time DM admissions were significantly higher during first 5-years after-injury for the burn cohort compared with the non-burn trauma cohort (HR, 95%CI: 2.00, 1.31–3.05) and non-injured cohort (HR, 95%CI: 1.96, 1.46–2.64); no difference was found >5years (burn vs. non-burn trauma: HR, 95%CI: 0.88, 0.70–1.12; burn vs non-injured: 95%CI: 1.08 0.82–1.41). No significant difference was found when comparing the non-burn trauma and non-injured cohorts (0–5 years: HR, 95%CI: 1.03, 0.71–1.48; >5years: HR. 95%CI: 1.11, 0.93–1.33). ConclusionsBurn and non-burn trauma patients experienced elevated rates of DM admissions after injury compared to the non-injured cohort over the duration of the study. While burn patients were at increased risk of incident DM admissions during the first 5-years after the injury this was not the case for non-burn trauma patients. Sub-group analyses showed elevated risk in both adult and pediatric patients in the burn and non-burn trauma. Detailed clinical data are required to help understand the underlying pathogenic pathways triggered by burn and non-burn trauma. This study identified treatment needs for patients after burn and non-burn trauma for a prolonged period after discharge.