title: Increased admissions for diabetes mellitus after burn.
abstract: BACKGROUND
  Currently, limited long-term data on hyperglycaemia and insulin sensitivity in burn patients are available and the data that do exist are primarily related to paediatric severe burns. The aim of this study was to assess if burn is associated with increased post-burn admissions for diabetes mellitus.
  
  
  METHODS
  A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalized for a first burn (n=30,997) in 1980-2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia's birth registrations and electoral roll (n=123,399). Crude admission rates and summed length of stay for diabetes mellitus were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively.
  
  
  RESULTS
  After adjustment for socio-demographic factors and pre-existing health status, the burn cohort had 2.21 times (95% Confidence Interval (CI): 1.36-1.56) as many admissions and almost three times the number of days in hospital with a diabetes mellitus diagnosis (IRR, 95% CI: 2.94, 2.12-4.09) than the uninjured cohort. Admission rates were significantly elevated for those burned during childhood (<18 years, IRR, 95% CI: 2.65, 1.41-4.97) and adulthood (≥18 years, IRR, 95% CI: 2.12, 1.76-2.55). Incident admissions were significantly elevated in the burn cohort during the first 5 years post-burn when compared with the uninjured (HR, 95% CI: 1.96, 1.46-2.64); no significant difference was found beyond 5 years post-burn (HR, 95% CI: 1.08, 0.82-1.41).
  
  
  CONCLUSIONS
  Findings of increased hospital admission rates and prolonged length of hospital stay for diabetes mellitus in the burn cohort provide evidence that burns have longer term effects on blood glucose and insulin regulation after wound healing. The first five years after burn discharge appears to be a critical period with significantly elevated incident admissions for diabetes mellitus during this time. Results would suggest prolonged clinical management after discharge and or wound healing to minimise post-burn admissions for diabetes mellitus is required.
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: janine.duke@uwa.edu.au.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Duke
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia. Electronic address: Sean.Randall@curtin.edu.au.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Randall
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: mark@fionawoodfoundation.com.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fear
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia. Electronic address: j.boyd@curtin.edu.au.
authors.forename: James H
authors.initials: JH
authors.lastname: Boyd
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: ohalloranemily@gmail.com.
authors.forename: Emily
authors.initials: E
authors.lastname: O'Halloran
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia. Electronic address: Suzanne.Rea@health.wa.gov.au.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rea
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia. Electronic address: Fiona.Wood@health.wa.gov.au.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000453:epidemiology* / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016247:Information Storage and Retrieval; D007333:Insulin Resistance; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Burns; Diabetes; Insulin; Long-term health; Population-based cohort