Disease Characteristics and Severity in Patients With Inflammatory Bowel Disease With Coexistent Diabetes Mellitus

Abstract

Background Given the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM. Methods Data of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment. Results Out of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn’s disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P < 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P < 0.001, gastroenterology clinic visits P < 0.001, and median annual charges P < 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations. Conclusions This study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

“…Hypoalbuminemia has been described as a negative prognostic factor in several diseases, [89][90][91][92]. Furthermore, low serum albumin concentrations have been shown to be associated with the severity of chronic inflammatory diseases, inflammatory bowel disease and diabetes mellitus [93], cirrhosis [94], as well as with the severity of surgical trauma [95], acute diseases [96] and sepsis [97]. In addition, in past SARS epidemics, hypoalbuminemia has been shown to be related with disease severity and increased hospital mortality [98,99].…”

Fermented Maillard Reaction Products by Lactobacillus gasseri 4M13 Alters the Intestinal Microbiota and Improves Dysfunction in Type 2 Diabetic Mice with Colitis

“…Younger IBD patients with microbial disorders are more susceptible to DM than non-IBD patients due to chronic inflammation and increased insulin levels [8]. Increased inflammation and gut microbial dysbiosis lead to both DM and IBD [9,10]. For both disorders, biotherapy research needs to develop incremental treatments with reduced side effects [3,11].…”

In-Hospital Outcomes of Inflammatory Bowel Diseases in Patients With Diabetes Mellitus: A Propensity Score Matching Analysis

“…Compared with IBD cohorts, IBD DM patients had significantly higher rates of sepsis and other infections [ 10 ]. Furthermore, a retrospective study that utilized 2810 outpatient cohorts concluded that DM is associated with worse IBD severity reflected by increased use of the emergency room and nearly double the rates of patients with gastrointestinal clinic visits [ 15 ]. While these studies have employed different databases and methodology, one consistent finding with these studies is the overall increase in the odds of infection-related complications among IBD DM patients compared to the IBD cohorts.…”

“…Given the overlapping impairment in the immune system, concomitant DM is a significant comorbidity among patients with IBD, as reflected by increased hospitalizations [ 15 ]. While our study did not find a significant difference in the length of hospital stay and cost of hospitalization between IBD DM and IBD, we did not explore health care utilization.…”

“…While our study did not find a significant difference in the length of hospital stay and cost of hospitalization between IBD DM and IBD, we did not explore health care utilization. A study found that IBD DM patients had a higher outpatient prescription and antibiotic usage than IBD cohorts [ 15 ]. Also, IBD DM patients' increased emergency department and gastrointestinal clinic visits reflected the important burden of IBD DM comorbidity [ 15 ].…”