title: Role of diabetes in the development of acute respiratory distress syndrome.
abstract: OBJECTIVE
  Diabetes has been associated with decreased development of acute respiratory distress syndrome in some, but not all, previous studies. Therefore, we examined the relationship between diabetes and development of acute respiratory distress syndrome and whether this association was modified by type of diabetes, etiology of acute respiratory distress syndrome, diabetes medications, or other potential confounders.
  
  
  METHODS
  Observational prospective multicenter study.
  
  
  METHODS
  Four adult ICUs at two tertiary academic medical centers.
  
  
  METHODS
  Three thousand eight hundred sixty critically ill patients at risk for acute respiratory distress syndrome from sepsis, pneumonia, trauma, aspiration, or massive transfusion.
  
  
  METHODS
  None.
  
  
  RESULTS
  Diabetes history was present in 25.8% of patients. Diabetes was associated with lower rates of developing acute respiratory distress syndrome on univariate (odds ratio, 0.79; 95% CI, 0.66-0.94) and multivariate analysis (adjusted odds ratio, 0.76; 95% CI, 0.61-0.95). After including diabetes medications into the model, diabetes remained protective (adjusted odds ratio, 0.75; 95% CI, 0.59-0.94). Diabetes was associated with decreased development of acute respiratory distress syndrome both in the subgroup of patients with sepsis (adjusted odds ratio, 0.77; 95% CI, 0.61-0.97) and patients with noninfectious etiologies (adjusted odds ratio, 0.30; 95% CI, 0.10-0.90). The protective effect of diabetes on acute respiratory distress syndrome development is not clearly restricted to either type 1 (adjusted odds ratio, 0.50; 95% CI, 0.26-0.99; p = 0.046) or type 2 (adjusted odds ratio, 0.77; 95% CI, 0.60-1.00; p = 0.050) diabetes. Among patients in whom acute respiratory distress syndrome developed, diabetes was not associated with 60-day mortality on univariate (odds ratio, 1.11; 95% CI, 0.80-1.52) or multivariate analysis (adjusted odds ratio, 0.81; 95% CI, 0.56-1.18).
  
  
  CONCLUSIONS
  Diabetes is associated with a lower rate of acute respiratory distress syndrome development, and this relationship remained after adjusting for clinical differences between diabetics and nondiabetics, such as obesity, acute hyperglycemia, and diabetes-associated medications. In addition, this association was present for type 1 and 2 diabetics and in all subgroups of at-risk patients.
authors: 1Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY. 2Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA. 3Environmental Health Department, Environmental and Occupational Medicine and Epidemiology Program, Harvard School of Public Health, Boston, MA. 4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors: Shun
authors: S
authors: Yu
authors: David C
authors: DC
authors: Christiani
authors: B Taylor
authors: BT
authors: Thompson
authors: Ednan K
authors: EK
authors: Bajwa
authors: Michelle Ng
authors: MN
authors: Gong
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications; D015995:Prevalence; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D007004:Hypoglycemic Agents
references: Arch Intern Med. 2007 Oct 8;167(18):1938-43
references: 17923592
references: Anaesthesia. 1984 May;39(5):468-9
references: 6731776
references: Am J Pathol. 2006 Jul;169(1):86-95
references: 16816363
references: Shock. 2005 Dec;24(6):547-55
references: 16317386
references: N Engl J Med. 2005 Oct 20;353(16):1685-93
references: 16236739
references: Am J Respir Crit Care Med. 2008 Aug 15;178(4):356-62
references: 18535257
references: Clin Infect Dis. 2006 Apr 15;42(8):1093-101
references: 16575726
references: J Mol Med (Berl). 1996 Feb;74(2):105-9
references: 8820406
references: Am J Respir Crit Care Med. 2007 Mar 15;175(6):587-94
references: 17185651
references: J Clin Invest. 2009 Nov;119(11):3450-61
references: 19809160
references: Crit Care Med. 2000 Sep;28(9):3137-45
references: 11008971
references: Crit Care Med. 2010 Feb;38(2):539-45
references: 19851093
references: Am J Respir Crit Care Med. 2011 Feb 15;183(4):462-70
references: 20802164
references: Lancet. 2005 Apr 9-15;365(9467):1333-46
references: 15823385
references: Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1818-24
references: 8520742
references: Clin Chest Med. 2006 Dec;27(4):705-24; abstract x
references: 17085257
references: Crit Care Med. 2012 Jun;40(6):1835-43
references: 22488007
references: Chest. 2010 Sep;138(3):559-67
references: 20507948
references: Crit Care Med. 2009 Aug;37(8):2455-64
references: 19531947
references: Diabetes Care. 2009 Jun;32(6):1119-31
references: 19429873
references: Zhonghua Yu Fang Yi Xue Za Zhi. 2002 Mar;36(2):93-6
references: 12410960
references: Crit Care Med. 1996 Feb;24(2):247-51
references: 8605796
references: Diabetes Care. 2011 Jan;34 Suppl 1:S11-61
references: 21193625
references: N Engl J Med. 2000 May 4;342(18):1334-49
references: 10793167
references: N Engl J Med. 1996 Mar 21;334(12):777-83
references: 8592553
references: Diabetes Care. 2003 Feb;26(2):510-3
references: 12547890
references: MMWR Recomm Rep. 2011 Jan 28;60(2):1-64
references: 21293327
references: Pediatrics. 2005 May;115(5):e553-60
references: 15867020
references: Pediatrics. 2006 Oct;118(4):1510-8
references: 17015542
references: Crit Care Med. 2006 Mar;34(3):758-64
references: 16505662
references: Thorax. 2010 Jan;65(1):44-50
references: 19770169
references: Am J Respir Crit Care Med. 2003 Jan 1;167(1):83-90
references: 12502480
references: Am J Respir Crit Care Med. 2000 Jan;161(1):85-90
references: 10619802
references: Proc Am Thorac Soc. 2005;2(3):226-31
references: 16222042
references: Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293-301
references: 7842182
references: Am J Physiol Lung Cell Mol Physiol. 2005 Jun;288(6):L1026-32
references: 15665042
references: Crit Care Med. 2008 Aug;36(8):2407-13
references: 18596634
references: Clin Exp Pharmacol Physiol. 2006 Sep;33(9):793-7
references: 16922808
references: Crit Care Med. 2000 Jul;28(7):2187-92
references: 10921539
references: Crit Care Med. 2008 May;36(5):1518-22
references: 18434908
references: Crit Care. 2009;13(1):R18
references: 19216780
references: MMWR Recomm Rep. 1997 Apr 4;46(RR-8):1-24
references: 9132580
references: J Trauma. 2007 Aug;63(2):351-7
references: 17693835
references: Stat Med. 1999 Mar 30;18(6):681-94
references: 10204197
references: JAMA. 1996 Jan 3;275(1):50-4
references: 8531287
references: Lancet. 2006 Mar 11;367(9513):847-58
references: 16530579
references: Curr Opin Crit Care. 2010 Feb;16(1):62-8
references: 19952736
references: Crit Care Med. 2005 Jun;33(6):1191-8
references: 15942330
references: Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1159-64
references: 9563734
references: Am J Physiol Lung Cell Mol Physiol. 2006 Sep;291(3):L307-11
references: 16648240
references: Diabetes Care. 2000 Oct;23(10):1516-26
references: 11023146
references: Braz J Med Biol Res. 2007 Aug;40(8):1037-44
references: 17665039
references: Acta Chir Scand. 1989 Mar;155(3):163-70
references: 2741624
references: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
references: 7509706
references: Crit Care. 2007;11(5):R96
references: 17784960
references: Crit Care Med. 2006 Mar;34(3):871-7
references: 16521285
references: Eur Respir J. 2011 Mar;37(3):604-9
references: 20562130
references: Anesthesiology. 2011 Jul;115(1):117-28
references: 21694510
references: Crit Care Med. 2011 Jun;39(6):1343-50
references: 21336116
references: Med Clin North Am. 1971 Jul;55(4):1031-44
references: 4946755
references: Intensive Care Med. 2005 Jul;31(7):922-6
references: 15856172
references: Diabet Med. 1997 Jan;14(1):29-34
references: 9017350
references: Chest. 2011 Feb;139(2):289-295
references: 20688925
references: Anesthesiology. 1989 Apr;70(4):591-7
references: 2929996
references: Shock. 2007 Jul;28(1):106-11
references: 17510605
references: Diabetologia. 2007 Mar;50(3):549-54
references: 17187246
references: Diabet Med. 2000 Nov;17(11):762-70
references: 11131100
references: Diabetes Care. 2006 Nov;29(11):2403-8
references: 17065675
references: Thorax. 2008 Dec;63(12):1083-9
references: 18566109
references: PLoS One. 2012;7(9):e44987
references: 23024779
references: Am J Respir Crit Care Med. 2008 Jul 15;178(2):168-79
references: 18436790
references: Am J Surg. 1982 Jul;144(1):124-30
references: 7091520
references: Inflamm Res. 2005 Nov;54(11):464-70
references: 16307220