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Diabetes linked to worse outcomes in IBD
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ORLANDO — Patients with diabetes and inflammatory bowel disease had significantly worse outcomes across several variables compared with IBD patients who did not have diabetes, according to a poster presented at AIBD 2016.
“This study is significant because it showed that IBD patients with concomitant diabetes had significantly higher morbidity and mortality over a 10-year period compared to patients with IBD alone,” Tatiana Teslova, MD, resident, Internal Medicine, Montefiore Health System in the Bronx, New York, told Healio Gastroenterology.
Because diabetes is associated with chronic inflammation and changes in gut microbial composition, Tatiana and colleagues, including Dana Lukin, MD, PhD, director of the Einstein-Montefiore Program for Inflammatory Bowel Diseases, sought to compare outcomes and disease severity in IBD patients with and without diabetes. Using a large institutional database, they performed a retrospective study of patients treated at Montefiore Medical Center between 2004 and 2014.
Tatiana Teslova
Dana Lukin
They identified 2,094 patients with IBD, 159 with both IBD and diabetes and 61,899 with diabetes and no IBD.
Outpatient visits, hospitalizations, deaths
Patients with both IBD and diabetes had a higher median number of annual outpatient visits compared with patients with just IBD (11 vs. 4; P < .0001), but both groups had a median of zero annual hospitalizations.
In addition, researchers observed a higher mortality rate among patients with both IBD and diabetes (5%) and diabetes alone (5%) vs. patients who just had IBD (2%; P < .0001).
Infection rates
In terms of infection rates, patients with both IBD and diabetes also had a higher Clostridium difficile infection rate (8%) compared with patients with just IBD (4%) and patients with just diabetes (2%; P < .0001). Moreover, patients with both IBD and diabetes had a higher rate of sepsis (8%) compared with the IBD (3%) and diabetes alone cohorts (5%; P < .0001), and they also had a higher rate of meningitis (2% vs. 1% and 0%, respectively; P = .002), abscess (8% vs. 7% and 3%, respectively; P < .0001), pneumonia (16% vs. 7% and 11%, respectively; P < .0001) and cellulitis (30% vs. 14% and 19%, respectively; P < .0001).
“Bacteremia rates were only 1% in all groups,” the investigators wrote.
Use of IBD therapy
Patients with both IBD and diabetes were more likely to use any IBD therapy compared with patients with IBD alone (55% vs. 32%; P < .0001). Specifically, they were also more likely to use mesalamine (36% vs. 19%; P < .0001) and steroids (38% vs. 22%; P < .0001), but they used immunomodulators and biologics in comparable proportions.
Inflammatory markers
Finally, patients with both IBD and diabetes more often had elevated inflammatory markers compared with patients with IBD alone; 53% of the IBD plus diabetes cohort had ESR levels above 20 compared with 33% of the IBD only cohort (P < .0001), and 30% vs. 20% had CRP levels above 0.8, respectively (P = .003).
Patients with IBD and diabetes also had a higher rate of smoking, but the researchers did not include these data.
“Some of the potential mechanisms to explain these adverse outcomes include additional alterations in the intestinal microbiome in combined disease group vs. IBD only patients, a chronically activated systemic inflammatory state, and activation of overlapping immune pathways,” Teslova said. “This study should prompt investigators to perform prospective and larger multicenter studies to validate these findings.” – by Adam Leitenberger
Reference:
Teslova T, et al. Abstract P-044. Presented at: Advances in Inflammatory Bowel Diseases; Dec. 8-10, 2016; Orlando, Fla.
Disclosures: The researchers report no relevant financial disclosures.