Pneumonia in Patients with Diabetes Mellitus: A Single-Center Experience

Objectives: The rate of infection and hospitalization due to infection as well as the risk of mortality are greater in patients with diabetes mellitus (DM). The aim of the present study was to determine the frequency of pneumonia, length of hospital stay, rate of patients requiring hospitalization in the intensive care unit (ICU), and rates of discharge or mortality among patients hospitalized due to DM in internal medicine inpatient clinics.
Methods: A total of 399 patients with DM (170 males and 229 females) were enrolled in the study. The frequency of pneumonia in the group was determined, and the length of hospital stay, rate of patients requiring hospitalization in ICU, discharge rate, mortality, and factors related to mortality were evaluated, comparing those with pneumonia and DM and those with DM alone.
Results: The frequency of pneumonia among the DM patients was 12% (48 cases). Hypertension was the most common comorbidity in the 2 groups (31.8% and 32.8%, respectively, among those with pneumonia and DM and those with DM alone). The rate of discharge, mortality, and the rate of patients transferred to the ICU was 92% (367 cases), 4% (16 cases), and 4% (16 cases). The length of hospital stay, discharge rate, mortality, and the rate of patients transferred to the ICU was similar between the patients with and without pneumonia (p>0.05 for each), but the length of hospital stay and the rate of patients transferred to the ICU was higher among patients with pneumonia (p<0.05 for each).
Conclusion: About 10% of diabetic patients were treated for pneumonia. Infection in patients with DM leads to a longer hospital stay and fewer hospital discharges. The Infection-related disease burden leads to serious morbidity in patients with DM, and therefore, longer hospital stay and more patients transferred to ICU.
1.Kovalaske MA, Gandhi GY. Glycemic control in the medical intensive care unit. J Diabetes Sci Technol 2009;3:1330–41. [CrossRef]
2. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care 2008;31:1541–5. [CrossRef]
3. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005;41:281–8. [CrossRef]
4. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003;26:510–3. [CrossRef]
5. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT. Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care 2007;30:2251– 7. [CrossRef]
6. Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005;128:3233–9. [CrossRef]
7. Di Yacovo S, Garcia-Vidal C, Viasus D, Adamuz J, Oriol I, Gili F, et al. Clinical features, etiology, and outcomes of community-acquired pneumonia in patients with diabetes mellitus. Medicine (Baltimore) 2013;92:42–50. [CrossRef]
8. McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care 2005;28:810–5. [CrossRef]
9. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87:978–82. [CrossRef]
10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243–50. [CrossRef]
11. Rueda AM, Ormond M, Gore M, Matloobi M, Giordano TP, Musher DM. Hyperglycemia in diabetics and non-diabetics: effect on the risk for and severity of pneumococcal pneumonia. J Infect 2010;60:99–105. [CrossRef]
12. ACE/ADA Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association Consensus statement on inpatient diabetes and glycemic control. Diabetes Care 2006;29:1955–62. [CrossRef]
13. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med 2006;355:1903–11. [CrossRef]
14. Castellanos MR, Fadel DA, Seminara DP. Brief report: glucose control in nondiabetic elderly patients with pneumonia may be an overlooked therapeutic target. Clin Geriatr 2008;16:25–6.