title: Diabetes mellitus and infective endocarditis: the insulin factor in patient morbidity and mortality.
abstract: OBJECTIVE
  To analyse the characteristics of infective endocarditis (IE) in patients with diabetes mellitus (DM), and to evaluate the prognostic significance of DM according to insulin use.
  
  
  RESULTS
  A total of 559 patients with definite IE including 75 patients (13%) with DM (insulin use n = 22; oral antidiabetic n = 53) were evaluated. Comparison of insulin-DM, oral-DM, and non-DM patients showed an older age (66 +/- 13, 66 +/- 10, 58 +/- 17, respectively; P = 0.004) in DM patients, and more frequent IE on prosthetic valves (32, 11, and 15%, respectively; P = 0.068) in insulin-DM patients. Oral streptococci (0, 8, and 18%, respectively; P = 0.016) were less frequently the causative organism than staphylococci (64, 26, and 29%, respectively; P = 0.002) in insulin-DM patients. Vegetations, dehiscence, abscess, and regurgitation rates did not differ among the three groups, nor did cardiac surgery rates (32, 47, and 48%, respectively; P = 0.334), but in-hospital mortality was higher in insulin-DM patients (50, 19, and 15%; P < 0.001). In multivariable analysis, independently of other determinants of death (age, IE location, Staphylococcus aureus, history of heart failure, immunosuppression, creatinine serum), insulin-DM was a predictor of death (OR, 4.69; 95% CI, 1.77-12.44), whereas oral-DM was not.
  
  
  CONCLUSIONS
  IE prognosis in insulin-DM patients is poor due to the coexistence of host and pathogen factors. Insulin-DM patients with IE may require specific management.
authors.affiliation: Université Paris 7, Denis Diderot, Laboratoire de pathologie Infectieuse, Paris, France. xavier.duval@bch.aphp.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Mainardi
authors.forename: Patrick
authors.initials: P
authors.lastname: Plesiat
authors.forename: Marie
authors.initials: M
authors.lastname: Célard
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
mesh_terms: D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000401:mortality*; D004697:Endocarditis, Bacterial / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin