Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study
Georges Khattar, Samer Asmar, Laurence Aoun, Fares Saliba, Shaza Almardini, Saif Abu Baker, Catherine Hong, Carolla El Chamieh, Fadi Haddadin, Toni Habib, Omar Mourad, Zeina Morcos, Fatema Arafa, Jonathan Mina, Khalil El Gharib, Mohammad Aldalahmeh, Salman Khan, Elie Bou Sanayeh
Georges Khattar, Laurence Aoun, Fares Saliba, Elie Bou Sanayeh, Department of Medicine, Holy Spirit University of Kaslik, Jounieh 00000, Lebanon
Samer Asmar, Shaza Almardini, Saif Abu Baker, Catherine Hong, Fadi Haddadin, Omar Mourad, Fatema Arafa, Salman Khan, Elie Bou Sanayeh, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
Carolla El Chamieh, Public Heath and Biostatistics, Independent Research, Beirut 0000, Lebanon
Toni Habib, Department of Medicine, Lebanese University, Beirut 00000, Lebanon
Zeina Morcos, Department of Medicine, University of Balamand, Beirut 00000, Lebanon
Jonathan Mina, Department of Medicine, Lebanese American University, Beirut 00000, Lebanon
Khalil El Gharib, Mohammad Aldalahmeh, Department of Medicine, Northwell Health Staten Island University Hospital, New York, NY 10305, United States
Co-first authors: Georges Khattar and Elie Bou Sanayeh.
Author contributions: Khattar G, Asmar S and Hong C conceptualized the study; Khattar G and Bou Sanayeh E designed the methodology; Asmar S and El Chamieh C performed validation; Khattar G, Bou Sanayeh E, El Chamieh C and Asmar S contributed software; Asmar S and El Chamieh C performed the formal analysis and provided various resources; Khattar G, Bou Sanayeh E, Aoun L, Saliba F, Asmar S, Mina J, Arafa F, Khan S, and Habib T participated in the formal investigation; Asmar S and Khattar G performed data curation; Bou Sanayeh E, Aoun L, Saliba S, Almardini S, Haddadin F, Abu Baker S, Morcos Z, Aldalahmeh M and Mourad O wrote the original draft of the manuscript; Khattar G and Hong C contributed to visualization of the data presentation; Khattar G and Bou Sanayeh E edited the manuscript for important intellectual content; Khattar G and Bou Sanayeh E supervised the study; all authors read and agreed to the published version of the manuscript. Khattar G and Bou Sanayeh E as co-first authors in this study, we emphasize their collaborative efforts, teamwork, and balanced contributions. They both made significant intellectual contributions throughout the research process. Here is the detailed justification: Collaborative Contribution: The research was conducted as a collaborative effort between Khattar G and Bou Sanayeh E. Their designation as co-first authors accurately reflects the shared distribution of responsibilities and efforts required for conducting the study and developing the resulting manuscript. Design and Data Analysis: Khattar G and Bou Sanayeh E were integral in designing the study and refining its protocol. They were equally involved in data collection, analysis, and interpretation, ensuring a comprehensive understanding of the data. Manuscript Preparation: They jointly drafted the manuscript, ensuring that the findings were presented accurately and effectively. Their close collaboration ensured a clear and cohesive narrative throughout. Equal Contribution: The designation of Khattar G and Bou Sanayeh E as co-first authors acknowledges their equal and significant contributions, respecting the spirit of teamwork and cooperation essential to this study.
Institutional review board statement: The retrospective design of the study using anonymized data from the Nationwide Inpatient Sample database.
Informed consent statement: Not applicable due to the retrospective design of the study using anonymized data from the Nationwide Inpatient Sample database.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Georges Khattar, MD, Research Fellow, Department of Medicine, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh 00000, Lebanon. geokhattar22@gmail.com
Received: February 28, 2024
Revised: April 28, 2024
Accepted: May 14, 2024
Published online: June 16, 2024
Processing time: 97 Days and 1.4 Hours
BACKGROUND
The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home.
AIM
To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.
METHODS
We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes.
RESULTS
Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge.
CONCLUSION
Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.
Core Tip: During the coronavirus disease 2019 (COVID-19) era, multiple studies have shown that outpatient insulin use was a bad prognosticator for COVID-19-induced acute respiratory distress syndrome (ARDS). After the use of greedy propensity matching to balance multiple confounders, this study demonstrated that outpatient insulin use has no impact on non-COVID-19-induced ARDS compared to the use of other anti-hyperglycemic agents in type 2 diabetes patients. The outcomes evaluated were mortality, length of stay, duration of intubation, cost of stay, and acute kidney injury. These findings raise a lot of unanswered questions on the relationship between diabetes and acute lung injury outcomes.
