title: Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus.
abstract: BACKGROUND
  We investigated the mortality rates of patients with and without diabetes mellitus after acute large-dose exposure to organophosphate insecticides. All patients without diabetes mellitus were traced to examine the long-term risk of new-onset diabetes mellitus. Previous reports indicated that organophosphate exposure might increase the risk of new-onset diabetes mellitus.
  
  
  METHODS
  We analyzed the records of 118 patients referred to Chang Gung Memorial Hospital for management of intentional organophosphate poisoning between 2000 and 2011. Patients were stratified by diabetes mellitus status. Demographic, clinical, laboratory and mortality data were analyzed.
  
  
  RESULTS
  Most patients were middle aged (53.45 ± 16.20 years) and male (65.3%) and were referred to our hospital after a relatively short amount of time had elapsed since poisoning (median 3.0 hours). 18 (15.2%) of 118 patients died, including 15 (13.8%) of 109 patients without diabetes mellitus and 3 (33.3%) of 9 with diabetes mellitus. There was no significant difference in mortality between these groups (P = 0.117). In a multivariate Cox regression model, hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and corrected QT interval prolongation (P = 0.002) were significant risk factors for mortality. Conversely, diabetes mellitus status was not a significant variable in this model. At routine outpatient follow up a median of 1.25 months post exposure, random blood glucose measurements gave no evidence of new-onset diabetes in patients without pre-existing diabetes.
  
  
  CONCLUSIONS
  Diabetes mellitus status might not increase mortality risk following acute large-dose exposure to organophosphates, and the risk of new-onset diabetes mellitus also might be minimal in the short term. Larger prospective studies with formal testing for diabetes at later times post-exposure are required.
authors.forename: Shou-Hsuan
authors.initials: SH
authors.lastname: Liu
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Hsin-Lan
authors.initials: HL
authors.lastname: Shen
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Chang
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan. m19570@adm.cgmh.org.tw.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002802:Cholinesterases / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000097:blood / Q000401:mortality*
chemical_list: D001786:Blood Glucose; D007306:Insecticides; D002802:Cholinesterases