Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients
Stuart L Daly1, Belinda J Gabbe, Rachel E Climie
1From the School of Public Health and Preventive Medicine (S.L.D., B.J.G., C.L.E.), Monash University; Emergency Medicine (S.L.D., C.L.E.), Alfred Health, Melbourne, VIC, Australia; Health Data Research UK (B.J.G.), Swansea University, Swansea, UK; Farr Institute (B.J.G.), Swansea University Medical School, Swansea University, Swansea, UK; Baker Heart and Diabetes Institute (R.E.C., C.L.E.), Melbourne; Menzies Institute for Medical Research (R.E.C.), University of Tasmania, Hobart, Tasmania, Australia; and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre (C.L.E.), Monash University, Melbourne, VIC, Australia.
Background:
Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients.
Methods:
In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥45 years) with major trauma were followed up at 24 months postinjury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using χ2 tests.
Results:
Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24 months postinjury and were followed up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared with people without T2D (16%; p < 0.001). After adjusting for confounders, people with T2D had poorer outcomes 24 months postinjury than people without T2D, with respect to functional recovery (Glasgow Outcome Scale Extended) (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.48-0.69) and return to work/study (AOR, 0.51; 95% CI, 0.37-0.71]). People with T2D experienced higher odds of problems with mobility (AOR, 1.92; 95% CI, 1.60-2.30), self-care (AOR, 1.94; 95% CI, 1.64, 2.29), usual activities (AOR, 1.50; 95% CI, 1.26-1.79), pain and discomfort (AOR, 1.75; 95% CI, 1.49-2.07), anxiety and depression (AOR, 1.45; 95% CI, 1.24, 1.70), and self-reported disability (AOR, 1.51; 95% CI, 1.28-1.79) than people without T2D.
Conclusion:
Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24 months postinjury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential.
Level Of Evidence:
Prognostic, level III.
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