The relationship to mortality and morbidity of patients with diabetes using oral anti-diabetic and intensive care due to sepsis

Objective: To investigate the effect of pre-existing treatment with oral antidiabetics on sepsis-related morbidity and mortality in patients with type 2 diabetes. Method: In this study, patients with Type 2 diabetes between the ages of 18-90 treated for sepsis in the tertiary intensive care unit between July 1 2017 and December 31 2022 will be retrospectively evaluated. Based on the oral antidiabetic medications used by the patients previously, mortality and morbidity will be analyzed. Results: The study involved 126 patients, with 51 of them being males (43.7%) and 75 being females (56.3%). The median level of glucose values of the patients was 252.5 (73.0- 542.0) mg/dL, and the median level of HbA1c values was 8.4% (6.1- 13.1). The number of patients dependent on mechanical ventilators was 75.4%, the most common antibiotic combination was vancomycin (73%) and meropenem (61.9%). The most frequently used oral antidiabetics by the patients are, respectively; Metformin + DPP4-i 28(22.2%), Metformin + SGLT2 Inhibitor 23(18.3%), Metformin + DPP4-i + SGLT2 Inhibitor 25(19.8%), Metformin 18(14.3%), Metformin + sulfonylurea 10 (7.9%), Metformin+ DPP4-i + sulfonylurea 9(7,1%). The median procalcitonin values of the patients were 3.4 μg/L in metformin, 1.7 μg/L in metformin + DPP4-i, 1.2 μg/L in metformin + SGLT2 inhibitors, and 2.2 μg/L in metformin + DPP4-i + SGTL2 inhibitors. Metformin + sulfonylurea 4.5 µg/L, linagliptin 1.6 µg/L, metformin + linagliptin 1.6 µg/L, and metformin + DPP4-i + sulfonylurea 1.9 µg/L (p<0.05). According to the applied Posthoc test results; Procalcitonin levels were the lowest in patients who received metformin + SGLT2 inhibitor. The median lactate values of the patients were 2.4 mmol/L in metformin, 2.2 mmol/L in metformin + DPP4-i, 1.8 mmol/L in metformin + SGLT2 inhibitor, 2.4 mmol/L in metformin + DPP4-i + SGTL2 inhibitor, 3 mmol/L in metformin + sulfonylurea, 3.1 mmol/L in linagliptin, 4.6 mmol/L in metformin + linagliptin, and 2.7 mmol/L in metformin + DPP4-i + sulfonylurea. (p<0.05). According to the applied Posthoc test results; It was observed that lactate values were the lowest in patients taking metformin + SGLT2 inhibitor. Patients receiving metformin+SGLT2 had a higher GCS score(mean:8); ventilator requirement was lower(39,2%) and statistically significant(p<0.05). Conclusion: Using Metformin+SGLT-2 inhibitors on diabetic patients receiving oral anti-diabetic drugs results in lower lactat level and lower procalcitonin levels, higher GCS level, lower ventilator requriment. Sepsis morbidity and mortality can be reduced with the use of metformin+SGLT-2 inhibitors before ICU admission. Keywords: Sepsis; Intensive care unit admission; Metformin+SGLT-2 inhibitor; Type 2 diabetes mellitus; Mortality; Morbidity