It is well known that healing is impaired in those with diabetes, which affects over 380 million people worldwide and is predicted to top half a billion by 2035, according to the International Diabetes Federation. However, data is lacking on the effects of diabetes on recovery from multiple system injuries. In an effort to address this knowledge gap, Peter Giannoudis from the University of Leeds, UK, and colleagues utilised data from the Trauma Audit and Research Network to analyse the clinical outcomes of polytrauma patients in association with their diabetic status, as published in a BMC Medicine study.
But why is it so important to understand the added risks involved during recovery in diabetics? Endocrinologist Robert Eckel from the University of Colorado at Denver, USA, explains…
It has been known for some time that healing is impaired in patients with diabetes. Validation is importantly needed following trauma, with a more extensive assessment of in-hospital metabolic control in addition to the extent and nature of the pre-morbid conditions. In this study in BMC Medicine on polytrauma, impaired healing is at least in part suggested by the length of hospital stay in patients with diabetes, and may also represent all-cause mortality.
Knowing that diabetes impairs healing following trauma, are there further subtleties to be considered dependent on whether the diabetes is insulin-dependent?
Patients on insulin are typically type 1 or advanced type 2 diabetics. Particularly in the latter case more co-morbidities may be present, and the ages of the ‘insulin-dependent’ diabetics implies that if they were type 1 they had more long-standing disease and therefore more complications.
With the public health burden of diabetes increasing, what changes do you think need to be made to ensure this group of patients receive optimal treatment following injury?
Optimal treatment of the trauma is the immediate need, but beyond that there is a need for understanding the importance of assessing the complications of diabetes, existing co-morbidities, and then avoiding extremes of glycaemia i.e. blood glucose more than 10 mM or less than 5 mM.
More about the researcher
Robert Eckel is Professor of Medicine in the Division of Endocrinology, Metabolism and Diabetes, and Cardiology at the University of Colorado at Denver, USA. He received his medical degree from the University of Cincinnati, USA, and went to train in internal medicine, specialising in endocrinology and metabolism. Eckel then joined the University of Colorado at Denver as an Assistant Professor of Medicine. His research focuses on the relationship between nutrition, insulin action, energy balance and body weight regulation. Eckel is also Director of the Lipid Clinic at the University Hospital of the University of Colorado at Denver, and an Editorial Board Member for BMC Medicine.