Don’t sugarcoat it

The bittersweet truth about diabetes is that it can be a challenge for both the practitioner and the patient to understand the consequences of the disease and the best ways to treat it. Early on in medical history, authors noted shorter lifespans, sexual dysfunction, and alterations in appetite of those whom had a “sweet taste” to their urine.1

Worldwide epidemic

Although the understanding of diabetes has increased, so too has its presence in the global population. Diabetes is a progressively growing epidemic in the U.S. as well. In fact, 29 million people in the U.S. are diabetic, with an even larger number who are prediabetic.2

The micro- and macrovascular complications related to this disease extend beyond those related to an elevated glucose level. Even in the modern era, the loss of eyesight, renal function, and even limb amputations are more common in diabetics than in non-diabetics.3 Furthermore, diabetes has been linked to increased morbidity and mortality in the setting of acute illness.4 The likelihood of morbidity resulting from wound healing and infectious complications is put to the test when a diabetic sustains an acute traumatic injury. These patients are more likely to have wound infections than burn patients, as well as prolonged intensive care unit (ICU) stays and days on the ventilator compared with non-diabetic injured patients.4,5

Effects on injured patients

To examine the effect of diabetes mellitus on cases of injury reported in the National Trauma Data Bank® (NTDB®) research dataset for admissions year 2014, medical records were searched by comorbidity code 11 (diabetes mellitus). The records were then divided into two groups: those for patients with diabetes (94,399) and those for patients without (866,157). A total of 792,761 records contained a discharge status. In comparing the diabetic group to the non-diabetic group respectively, 50 percent and 70.3 percent of patients were discharged to home; 16.3 percent and 11.4 percent to acute care/rehab; and almost twice as many to a skilled nursing facility—29.3 percent and 15.2 percent. There were 40 percent more deaths in the diabetic group—4.4 percent versus 3.2 percent (see Figures 1 and 2). The diabetic patients were more than 20 years older on average (68 years of age) than the non-diabetic group (an average of 47 years old). The diabetic group had an average hospital length of stay of 6.2 days versus the non-diabetic group’s 4.9 days. Patients were on the ventilator for an average of 7.2 and 5.9 days, respectively. Of those tested for alcohol, 22 percent of the diabetics had alcohol present, whereas more than one-third (35 percent) of non-diabetics tested positive for alcohol.

Figure 1. Hospital discharge status for diabetics

Figure 1

Figure 2. Hospital discharge status for non-diabetics

Figure 2

Direct effects of glucose derangements can lead to injury from motor vehicle collisions and falls.6 However, a patient’s diabetes is more often a secondary disease process needing to be treated while they recover. Health care professionals’ understanding of the breadth of consequences that can come from having diabetes is on the rise. As its presence in the health care population becomes more common, one should not lose sight of the critical nature this diagnosis has on the well-being and recovery of our patients.

Patients often ask trauma surgeons for prognoses. When it comes to diabetic trauma, surgeons should not sugarcoat it.

Throughout the year, we will be highlighting NTDB data through brief reports in the Bulletin. The National Trauma Data Bank Annual Report 2015 is available on the ACS website as a PDF file on the ACS website. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.

Acknowledgement

Statistical support for this article was provided by Chrystal Caden-Price, Data Analyst, NTDB.

References

  1. Lakhtakia R. The history of diabetes mellitus. Sultan Qaboos Univ Med J. 2013;13(3):368-370.
  2. Centers for Disease Control and Prevention. 2014 National Diabetes Statistics Report. Available at: www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html. Accessed September 23, 2016.
  3. American Diabetes Association. Statistics about Diabetes. Available at: www.diabetes.org/diabetes-basics/statistics/. Accessed September 23, 2016.
  4. Sayampanathan AA. Systematic review of complications and outcomes of diabetic patients with burn trauma. Burns. August 29, 2016. Available at: www.burnsjournal.com/article/S0305-4179(16)30201-7/abstract. Accessed September 23, 2016.
  5. Ahmad R, Cherry RA, Lendel I, et al. Increased hospital morbidity among trauma patients with diabetes mellitus compared with age- and injury severity score-matched control subjects. Arch Surg. 2007;142(7):613-618.
  6. El-Menyar A, Mekkodathil A, Al-Thani H. Traumatic injuries in patients with diabetes mellitus. J Emerg Trauma Shock. 2016;9(2):64-72.

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