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. 2018 Oct 25;7(11):385.
doi: 10.3390/jcm7110385.

High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Geng-He Chang  1   2   3 , Meng-Chang Ding  4 , Yao-Hsu Yang  5   6   7 , Yung-Hsiang Lin  8 , Chia-Yen Liu  9 , Meng-Hung Lin  10 , Ching-Yuan Wu  11   12 , Cheng-Ming Hsu  13   14 , Ming-Shao Tsai  15   16   17
Affiliations

High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Geng-He Chang et al. J Clin Med. .

Abstract

Objective: To investigate the risk of deep neck infection (DNI) in patients with type 1 diabetes mellitus (T1DM).

Methods: The database of the Registry for Catastrophic Illness Patients, affiliated to the Taiwan National Health Insurance Research Database, was used to conduct a retrospective cohort study. In total, 5741 patients with T1DM and 22,964 matched patients without diabetes mellitus (DM) were enrolled between 2000 and 2010. The patients were followed up until death or the end of the study period (31 December 2013). The primary outcome was the occurrence of DNI.

Results: Patients with T1DM exhibited a significantly higher cumulative incidence of DNI than did those without DM (p < 0.001). The Cox proportional hazards model showed that T1DM was significantly associated with a higher incidence of DNI (adjusted hazard ratio, 10.71; 95% confidence interval, 6.02⁻19.05; p < 0.001). The sensitivity test and subgroup analysis revealed a stable effect of T1DM on DNI risk. The therapeutic methods (surgical or nonsurgical) did not differ significantly between the T1DM and non-DM cohorts. Patients with T1DM required significantly longer hospitalization for DNI than did those without DM (9.0 ± 6.2 vs. 4.1 ± 2.0 days, p < 0.001). Furthermore, the patients with T1DM were predisposed to DNI at a younger age than were those without DM.

Conclusions: T1DM is an independent risk factor for DNI and is associated with a 10-fold increase in DNI risk. The patients with T1DM require longer hospitalizations for DNI and are younger than those without DM.

Keywords: abscess; cellulitis; cervical; deep neck infection; diabetes mellitus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Enrollment schema of the study and comparison cohorts. Abbreviations: RFCIP, Registry for Catastrophic Illness Patients; LHID2000, Longitudinal Health Insurance Database 2000; DM, diabetes mellitus; T1DM, type 1 diabetes mellitus; DNI, deep neck infection.
Figure 2
Figure 2
Cumulative incidence of DNI in the T1DM versus non-DM cohorts. Kaplan–Meier analysis demonstrated the cumulative DNI identified in the T1DM and non-DM cohorts during the 10-year follow-up period. The log-rank test revealed a significantly higher cumulative incidence in the T1DM cohort than in the non-DM cohort (p < 0.001).
Figure 3
Figure 3
Age distribution of DNI in the T1DM and non-DM cohorts. The peak age of DNI occurrence in the non-DM cohort was 21–40 years, while those in the T1DM cohort were 10–20 years and 21–40 years.
See this image and copyright information in PMC

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