Risks of Developing Diabetes and Hyperglycemic Crisis Following Carbon Monoxide Poisoning: A Study Incorporating Epidemiologic Analysis and Animal Experiment

Abstract

Chien-Cheng Huang,1– 3 Tzu-Hao Chen,3,4 Chung-Han Ho,4,5 Yi-Chen Chen,4 Rong-Jane Chen,3,6 Ying-Jan Wang,3 Chien-Chin Hsu,1 Hung-Jung Lin,1,7 Jhi-Joung Wang,8,9 Ching-Ping Chang,4 How-Ran Guo3,10,11 1Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 6Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; 8Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; 9Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan; 10Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 11Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, TaiwanCorrespondence: Chien-Cheng Huang, Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan, Tel [phone], Fax [phone], Email [email protected] How-Ran Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, Tainan, 701, Taiwan, Tel [phone], Fax [phone], Email [email protected]: Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues.Methods: Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning.Results: Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18– 1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52– 2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus.Conclusion: Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments.Keywords: animal, carbon monoxide poisoning, diabetes, epidemiology, hypothalamus, pancreas

Keywords

• animal
• carbon monoxide poisoning
• diabetes
• epidemiology
• hypothalamus
• pancreas.