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Hypothesis: We hypothesized that patients with diabetes mellitus (DM) have worse outcomes following trauma compared with patients without a history of DM. Design: Retrospective data analysis of the Pennsylvania Trauma Systems Foundation database that compiles data from 27 accredited trauma centers in Pennsylvania. Setting: We used the Pennsylvania Trauma Systems Foundation database of 295 561 patients to compare outcomes in patients with DM vs those in patients who did not have DM. Patients: A total of 12 489 patients with DM from January 1984 to December 2002 were matched by sex, age, and Injury Severity Score with 12 489 patients who did not have DM. Main Outcome Measures: Differences in the length of hospital stay, intensive care unit stay, ventilatory assistance days, complications, and mortality rates. Results: Patients with DM spent more days in the intensive care unit and receiving ventilator support. They were more likely to have a complication (23.0% in the DM group vs 14.0% in the non-DM group [odds ratio, 1.80; 95% confidence interval, 1.69-1.92]). No difference in mortality rates or length of hospital stay was noted. Conclusion: Patients with DM exposed to trauma have greater hospital morbidity resulting from longer intensive care unit stay, increased ventilator support, and more complications.

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Background-Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing Type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes.