Elsevier

Burns

Volume 44, Issue 3, May 2018, Pages 566-572
Burns

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

https://doi.org/10.1016/j.burns.2017.10.019Get rights and content

Highlights

  • Burns and non-burn trauma patients have higher DM admissions than non-injured.

  • Burns patients have higher post-discharge DM admission rates than non-burn trauma.

  • Burns patients have higher first-time DM admissions for 5-years than non-burn trauma.

Abstract

Objective

To 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.

Methods

Linked 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.

Results

The 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 >5 years (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).

Conclusions

Burn 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.

Introduction

It is now accepted that hyperglycaemia, glucose intolerance and insulin resistance occur after many acute illnesses, surgery and injuries, including burns, and in patients with no prior history of Type 2 diabetes [1], [2], [3], [4], [5], [6], [7]. The patterns and severity of these responses differ between types of trauma and sepsis [8], [9]. Burns trigger profound stress responses and hypermetabolism that can persist for many years, whereas for other trauma and sepsis, the severity and length of these responses are reported to be of less magnitude [10], [11], [12], [13].

Our previous research found that burn patients had significantly higher hospital admission rates for diabetes mellitus for a prolonged period after the injury when compared with uninjured people [14], providing evidence that burns have longer term effects on blood glucose and insulin regulation after wound healing. This study also identified the first five years after burn discharge as a critical period with significantly elevated incident admissions for diabetes mellitus observed during this time.

The persistence of effects and underlying pathophysiological pathways after burns and other trauma are complex and not fully understood. The objective of this study was to build on our previous population-based burns research and compare post-injury diabetes mellitus (DM) morbidity experienced by burns patients with other non-burn trauma patients and uninjured people.

Section snippets

Methods

This project was approved by the Human Research Ethics Committees of the Western Australian Department of Health and the University of Western Australia, and is a sub study of the Western Australian Population-based Burn Injury Project [14].

This study analysed linked hospital (Hospital Morbidity Data System) and death register data of 30,997 people hospitalised with a first burn in Western Australia during the period 1980–2012 and two comparison cohorts (i) non-burn trauma patients (n = 28,647);

Results

Of the burn cohort (n = 30,997), 283 (0.9%) died during index admission and 3587 (11.6%) died (any cause) after discharge. Of those that died during index 0.8% had minor burns (<20%TBSA); 10.5% had severe burns (≥20% TBSA); and, for 0.5%, TBSA was unspecified. Fourteen percent (n = 4390) of the burn cohort had full thickness burns sites recorded, 40% (n = 12,307) partial thickness, 17% (n = 5335) erythema burns recorded; burn depth was unspecified for 31% (n = 9708). Burn locations included head and neck

Discussion

The findings of this study confirmed increased DM morbidity after burn and non-burn trauma, suggesting prolonged effects of injury on blood glucose and insulin regulation. Compared with age and gender frequency matched uninjured people, patients with burns and other trauma had 2.2 times and 1.6 times higher rates of hospital admissions for DM, respectively, for a prolonged period after discharge. Children younger than 18 years at the time of the burn or other trauma experienced admission rates

Conclusions

Burn and non-burn trauma patients experienced elevated rates of post-injury DM admissions compared to the non-injured cohort over the duration of the study. This study found burn patients to be at significantly 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 for both burn and non-burn trauma. Detailed prospective clinical data are

Financial disclosure statement

All authors do not have financial disclosures relevant to this article to declare.

Contributor’s statement page

All authors have made contributions to the paper and authorized submission:

Janine Duke: Conception of study design, data analysis, interpretation, drafting of article, revisions and approved final manuscript as submitted.

Sean Randall, James Boyd: Data analysis, interpretation, drafting of article, revisions and approved final manuscript as submitted.

Mark Fear, Fiona Wood, Suzanne Rea: Interpretation, critical review and revisions, approved final manuscript as submitted.

Funding source

Project costs were supported by a Raine Medical Research Foundation Priming grant (JMD) and Woodside corporate sponsorship via the Fiona Wood Foundation.

Conflict of interest

All authors declare no conflicts of interest.

Acknowledgements

The authors thank the staff of the Health Information Linkage Branch for access to the Western Australian Data Linkage System and for their assistance in obtaining the data, the WA Health Data Custodians for access to the core health datasets and the Western Australian Department of Health.

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