USE OF ORAL ANTI-DIABETIC DRUGS AND RISK OF HOSPITAL AND ICU ADMISSIONS FOR INFECTIONS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Sepsis is one of the leading causes of ICU mortality, and diabetes is a significant risk factor for the development of infections. Hyperglycemia has been associated with altered immune function and increased severity of infections. A growing amount of evidence suggests an association between pre-admission metformin use and decreased rates of sepsis and inpatient mortality. However, the risk of developing infections among patients with type 2 diabetes taking newer classes of oral anti-diabetic drugs (OADs) is uncertain. The aim of our study is to examine the association between outpatient OAD use and hospital admissions for infections. METHODS: This is a national retrospective data analysis utilizing the Veterans Health Affairs Corporate Data Warehouse. We identified patients 18 years old and older with diabetes who filled at least 1 OAD prescription in calendar years 2013-2017. Patients were classified as taking metformin, sulfonylureas, alpha-glucosidase inhibitors, meglitinides, thiazolidinediones, DPP4 inhibitors, or SGLT2 inhibitors at any point during the five-year study period regardless of admission date. The endpoint was defined as a hospital admission with an infectious condition on the admission or discharge diagnosis list. Multivariate logistic regression was used to estimate the effect of each drug class on admission while adjusting for age, sex, race, smoking status, and Elixhauser Comorbidity Index. RESULTS: The cohort included 1.39 million patients with diabetes who were 95.8% male, 72.2% White, 20.3% smokers, and had a mean age of 70.5 years. Of those admitted to a hospital for infection, 7.5% required ICU level of care. After adjusting for covariates, those who took metformin during the study period had 3.3% lower odds of hospital admission for infection compared to those who were never on metformin (OR 0.97, 95% CI 0.95-0.98). OADs that were associated with a statistically significant increased odds of being admitted included meglitinides (OR 1.22, 95% CI 1.07-1.38), SGLT2 inhibitors (OR 1.16, 95% CI 1.08-1.24), alpha-glucosidase inhibitors (OR 1.09, 95% CI 1.04-1.15), and DPP4 inhibitors (OR 1.04, 95% CI 1.01-1.06). CONCLUSIONS: Metformin was associated with lower odds of admission for infection while meglitinides, SGLT2 inhibitors, alpha-glucosidase inhibitors, and DPP4 inhibitors were associated with higher odds of admission for infection. The effect sizes for most OADs were small with likely limited clinical relevance to individual patients. However, as OADs are widely prescribed, there could be implications at a population level. CLINICAL IMPLICATIONS: These findings suggest there may be an association between outpatient use of certain OADs and the development of infections requiring hospital admission. However, additional studies with time dependent exposure need to be carried out to further evaluate this association and infer causality. DISCLOSURES: No relevant relationships by Xiangqin Cui, source=Web Response No relevant relationships by Julia Gallini, source=Web Response No relevant relationships by Christine Jasien, source=Web Response Chief Medical Officer, President, Board relationship with Diasyst, Inc Please note: $1-$1000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Stock Research support relationship with Department of Veterans Affairs Please note: >$100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Salary Research support relationship with National Institutes of Health Please note: >$100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=research support Scientific Advisory Board relationship with Janssen Please note: $1001 - $5000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Honoraria Scientific Advisory Board relationship with Boeringer Ingelheim Please note: $1001 - $5000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Honoraria Research support relationship with Janssen Please note: >$100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=research support Research support relationship with Eli Lilly Please note: $20001 - $100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=research support Research support relationship with Abbvie Please note: $20001 - $100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Grant/Research Support Research support relationship with Glaxo SmithKline Please note: $20001 - $100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Grant/Research Support Research support relationship with Pfizer Please note: >$100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=research support Research support relationship with Novo Nordisk Please note: >$100000 Added 05/10/2020 by Lawrence Phillips, source=Web Response, value=Grant/Research Support No relevant relationships by Jeeyon Rim, source=Web Response No relevant relationships by Ruxana Sadikot, source=Web Response No relevant relationships by Aaron Trammell, source=Web Response