OBJECTIVE -To examine whether diabetes is a risk factor for hospitalization with pneumonia and to assess the impact of A1C level on such risk. RESEARCH DESIGN AND METHODS-In this population-based, case-control study we identified patients with a first-time pneumonia-related hospitalization between 1997 and 2005, using health care databases in northern Denmark. For each case, 10 sex-and age-matched population control subjects were selected from Denmark's Civil Registration System. We used conditional logistic regression to compute relative risk (RR) for pneumonia-related hospitalization among subjects with and without diabetes, controlling for potential confounding factors.RESULTS -The study included 34,239 patients with a pneumonia-related hospitalization and 342,390 population control subjects. The adjusted RR for pneumonia-related hospitalization among subjects with diabetes was 1.26 (95% CI 1.21-1.31) compared with nondiabetic individuals. The adjusted RR was 4.43 (3.40 -5.77) for subjects with type 1 diabetes and 1.23 (1.19 -1.28) for subjects with type 2 diabetes. Diabetes duration Ն10 years increased the risk of a pneumonia-related hospitalization (1.37 [1.28 -1.47]). Compared with subjects without diabetes, the adjusted RR was 1.22 (1.14 -1.30) for diabetic subjects whose A1C level was Ͻ7% and 1.60 (1.44 -1.76) for diabetic subjects whose A1C level was Ն9%.CONCLUSIONS -Type 1 and type 2 diabetes are risk factors for a pneumonia-related hospitalization. Poor long-term glycemic control among patients with diabetes clearly increases the risk of hospitalization with pneumonia.

OBJECTIVE -We sought to examine whether type 2 diabetes increases risk of death and complications following pneumonia and to assess the prognostic value of admission hyperglycemia.RESEARCH DESIGN AND METHODS -This was a population-based cohort study of adults with a first-time hospitalization for pneumonia between 1997 and 2004 (n ϭ 29,900) in northern Denmark. Information on diabetes, comorbidity, laboratory findings, pulmonary complications, and bacteremia was obtained from medical databases. We used regression to compute adjusted relative risks of pulmonary complications, bacteremia, and mortality rate ratios (MRRs) within 90 days following hospitalization among patients with and without type 2 diabetes. The prognostic impact of admission hyperglycemia was studied in a subcohort (n ϭ 13,574).RESULTS -In total, 2,931 (9.8%) pneumonia patients had type 2 diabetes. Mortality among diabetic patients was greater than that among other patients: 19.9 vs. 15.1% after 30 days and 27.0 vs. 21.6% after 90 days, respectively, corresponding to adjusted 30-and 90-day MRRs of 1.16 (95% CI 1.07-1.27) and 1.10 (1.02-1.18). Presence of type 2 diabetes did not predict pulmonary complications or bacteremia. Adjustment for hyperglycemia attenuated the association between type 2 diabetes and mortality. High glucose level on admission was a predictor of death among patients with diabetes and more so among those without diagnosed diabetes: adjusted 30-day MRRs for glucose level Ն14 mmol/l were 1.46 (1.01-2.12) and 1.91 (1.40 -2.61), respectively. CONCLUSIONS -Type 2 diabetes and admission hyperglycemia predict increased pneumonia-related mortality. Diabetes Care 30:2251-2257, 2007M ortality among adults hospitalized with community-acquired pneumonia (CAP) ranges from 6 to 14% (1). Advanced age and comorbidity are associated with increased mortality in these patients (2-4). Given the hyperglycemia, decreased immunity, impaired lung function, and chronic complications, such as renal failure, heart disease, and pulmonary microangiopathy, associated with diabetes (5), it is plausible that diabetes may predict increased severity of pneumonia. However, results of recent observational studies and a meta-analysis of pneumonia-related mortality, based on pre-1996 research, were inconsistent (6 -10). The discrepancies could stem from the use of clinic-based cohorts, confounding, or incomplete follow-up. Better diagnostic surveillance of diabetic patients may result in lower-than-expected mortality from pneumonia. Most studies lack data on pneumonia severity at hospitalization in diabetic versus nondiabetic patients (6,8 -10), whereas claims that diabetic pneumonia patients have an increased risk of developing bacteremia (5,11) are questionable because data on availability of blood cultures are often absent. Evidence regarding pulmonary complications in diabetic patients with pneumonia is scant (5,7), as are data on the prognostic value of acute hyperglycemia for diabetic patients with pneumonia (10).As prevalences of diabetes (12) and pneumon...

Aims To assess the effect of liraglutide, a once-daily human glucagon-like peptide-1 analogue on pancreatic B-cell function.Methods Patients with Type 2 diabetes ( n = 39) were randomized to treatment with 0.65, 1.25 or 1.9 mg/day liraglutide or placebo for 14 weeks. First-and second-phase insulin release were measured by means of the insulin-modified frequently sampled intravenous glucose tolerance test. Arginine-stimulated insulin secretion was measured during a hyperglycaemic clamp (20 mmol/l). Glucose effectiveness and insulin sensitivity were estimated by means of the insulin-modified frequently sampled intravenous glucose tolerance test. ResultsThe two highest doses of liraglutide (1.25 and 1.9 mg/day) significantly increased first-phase insulin secretion by 118 and 103%, respectively ( P < 0.05). Second-phase insulin secretion was significantly increased only in the 1.25 mg/day group vs. placebo. Arginine-stimulated insulin secretion increased significantly at the two highest dose levels vs. placebo by 114 and 94%, respectively ( P < 0.05). There was no significant treatment effect on glucose effectiveness or insulin sensitivity.Conclusions Fourteen weeks of treatment with liraglutide showed improvements in first-and second-phase insulin secretion, together with improvements in arginine-stimulated insulin secretion during hyperglycaemia. Diabet. Med. 25, 152-156 (2008)

This study provides evidence against the hypothesis that statin use has an effect on short-term mortality after bacteremia. Statin use was, however, associated with a substantially decreased mortality between 31 and 180 days after bacteremia.