Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients

Stuart Daly, Belinda J. Gabbe, Rachel E. Climie, Christina L. Ekegren

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Abstract

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 post injury. 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 chi-square tests. Results Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24-months post-injury 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 to people without T2D (16%), p < 0.001. After adjusting for confounders, people with T2D had poorer outcomes 24-months post injury than people without T2D, with respect to functional recovery (Extended Glasgow Outcome Scale) (adjusted odds ratio [AOR] [95% CI]: 0.58 [0.48, 0.69]) and return to work/study (AOR [95% CI]: 0.51 [0.37, 0.71]). People with T2D experienced higher odds of problems with mobility (AOR [95% CI]: 1.92 [1.60, 2.30]), self-care (AOR [95% CI]: 1.94 [1.64, 2.29]), usual activities (AOR [95% CI]: 1.50 [1.26, 1.79]), pain and discomfort (AOR [95% CI]: 1.75 [1.49, 2.07]), anxiety and depression (AOR [95% CI]: 1.45 [1.24, 1.70]), and self-reported disability (AOR [95% CI]: 1.51 [1.28, 1.79]) than people without T2D. Conclusions Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24-months post-injury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential.
Original languageEnglish
Number of pages56
JournalThe Journal of Trauma and Acute Care Surgery
DOIs
Publication statusAccepted/In press - 17 Jun 2021

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