Observational studyCritical care (London, England)2016
Association of diabetes and diabetes treatment with the host response in critically ill sepsis patients.
Observational study in Critical care (London, England), 2016. The graph read 2 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. Cited by 40 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
Read, but not usablea number the graph found but could not read as for or against
Chronic insulin treatment did not influence the mortality risk at 90 days when corrected for baseline differences in age, gender, malignancy and renal insufficiency (HR 1.10, 95 % CI 0.72, 1.69) nor when corrected for the APACHE IV score (HR 0.87, 95 % CI 0.58, 1.30).
Chronic metformin treatment did not influence the mortality risk at 90 days when corrected for baseline differences in age, gender and renal insufficiency (HR 0.75, 95 % CI 0.48, 1.15) nor when corrected for the APACHE IV score (HR 0.81, 95 % CI 0.54, 1.21).
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Where it lands on the map
Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.
What it adds to each cell
For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.
Insulin×all-cause mortality
No readable resultOpen on the map →What to test next →No other readable study in this cell yet. This paper is the evidence.
Metformin×all-cause mortality
No readable resultOpen on the map →What to test next →1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.
This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Association of preadmission metformin use and prognosis in patients with sepsis with diabetes: a systematic review and meta-analysis.Frontiers in endocrinology · 2026 · on this mapPooled it
- Association of Preadmission Metformin Use and Prognosis in Patients With Sepsis and Diabetes Mellitus: A Systematic Review and Meta-Analysis.Frontiers in endocrinology · 2021Pooled it
- Association of preadmission metformin use and mortality in patients with sepsis and diabetes mellitus: a systematic review and meta-analysis of cohort studies.Critical care (London, England) · 2019 · on this mapPooled it
- Data-driven spatial-temporal framework for exploring the heterogeneity and temporality of sepsis.Chinese medical journal · 2026Review
- Integrating Admission Hyperglycemia Into Multidisciplinary Risk Stratification for Sepsis in the ICU: A Retrospective Cohort Study.Journal of multidisciplinary healthcare · 2026Article
- Transcending metabolic acidosis: lactate as an epigenetic signal reprogramming diabetes-sepsis immunity.Frontiers in immunology · 2026Review
- Periapical abscess precipitating diabetic ketoacidosis and reversible sepsis-induced cardiomyopathy: a case report.Frontiers in endocrinology · 2026Article
- Effect of Anti-Diabetic Medication Use on Sepsis Risk in Type 2 Diabetes Mellitus: A Multivariate Analysis.Geriatrics (Basel, Switzerland) · 2025Article
- Machine learning algorithms for risk factor selection with application to 60-day sepsis morbidity risk for a geriatric hip fracture cohort.BMC geriatrics · 2025Article
- Sepsis Burden in a Major Romanian Emergency Center-An 18-Year Retrospective Analysis of Mortality and Risk Factors.Medicina (Kaunas, Lithuania) · 2025Article
- The Impact of Steatotic Liver Disease on Cytokine and Chemokine Kinetics During Sepsis.International journal of molecular sciences · 2025Article
- XueBiJing injection reduced mortality in sepsis patients with diabetes.Frontiers in pharmacology · 2025Article
- Bioinformatics-based screening and validation of ferroptosis-related genes in sepsis and type 2 diabetes mellitus.Experimental biology and medicine (Maywood, N.J.) · 2025Article
- Neutrophil-based single-cell sequencing combined with transcriptome sequencing to explore a prognostic model of sepsis.Scientific reports · 2024Article
- Mitochondrial dysfunction in sepsis: mechanisms and therapeutic perspectives.Critical care (London, England) · 2024Review
- Insight on Infections in Diabetic Setting.Biomedicines · 2023Review
- Intensive insulin therapy in sepsis patients: Better data enables better intervention.Heliyon · 2023Review
- New potential for an old kid on the block: Impact of premorbid metformin use on lactate kinetics, kidney injury and mortality in sepsis and septic shock, an observational study.Endocrinology, diabetes & metabolism · 2023Observational
- Association between Wait Time for Transthoracic Echocardiography and 28-Day Mortality in Patients with Septic Shock: A Cohort Study.Journal of clinical medicine · 2022Article
- Machine learning models to predict in-hospital mortality in septic patients with diabetes.Frontiers in endocrinology · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The marked sentences are the ones the graph read a number from.
backgroundDiabetes is associated with chronic inflammation and activation of the vascular endothelium and the coagulation system, which in a more acute manner are also observed in sepsis. Insulin and metformin exert immune modulatory effects. In this study, we aimed to determine the association of diabetes and preadmission insulin and metformin use with sepsis outcome and host response.
methodsWe evaluated 1104 patients with sepsis, admitted to the intensive care unit and stratified according to the presence or absence of diabetes mellitus. The host response was examined by a targeted approach (by measuring 15 plasma biomarkers reflective of pathways implicated in sepsis pathogenesis) and an unbiased approach (by analyzing whole genome expression profiles in blood leukocytes).
resultsDiabetes mellitus was not associated with differences in sepsis presentation or mortality up to 90 days after admission. Plasma biomarker measurements revealed signs of systemic inflammation, and strong endothelial and coagulation activation in patients with sepsis, none of which were altered in those with diabetes. Patients with and without diabetes mellitus, who had sepsis demonstrated similar transcriptional alterations, comprising 74 % of the expressed gene content and involving over-expression of genes associated with pro-inflammatory, anti-inflammatory, Toll-like receptor and metabolic signaling pathways and under-expression of genes associated with T cell signaling pathways. Amongst patients with diabetes mellitus and sepsis, preadmission treatment with insulin or metformin was not associated with an altered sepsis outcome or host response.
conclusionsNeither diabetes mellitus nor preadmission insulin or metformin use are associated with altered disease presentation, outcome or host response in patients with sepsis requiring intensive care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.