Impact of High-Dose Early Mobilization on Outcomes for Patients with Diabetes: A Secondary Analysis of the TEAM Trial
Date
2024
Authors
Serpa Neto, A.
Bailey, M.
Seller, D.
Agli, A.
Bellomo, R.
Brickell, K.
Broadley, T.
Buhr, H.
Gabbe, B.J.
Gould, D.W.
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Journal article
Citation
American Journal of Respiratory and Critical Care Medicine, 2024; 210(6):779-787
Statement of Responsibility
Ary Serpa Neto, Michael Bailey, Daniel Seller, Alicia Agli, Rinaldo Bellomo, Kathy Brickell, Tessa Broadley, Heidi Buhr, Belinda J. Gabbe, Doug W. Gould, Meg Harrold, Alisa M. Higgins, Sally Hurford, Theodore J. Iwashyna, Alistair D. Nichol, Jeffrey J. Presneill, Stefan J. Schaller, Janani Sivasuthan, Claire J. Tipping, Alex Poole, Rachael Parke, Scott Bradley, Steven Webb, Sophia Zoungas, Paul J. Young, and Carol L. Hodgson, on behalf of the TEAM Study Investigators
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Abstract
Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status. Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0–153] vs. 147 [82–164]; P = 0.013) and higher 180-day mortality (30% vs. 18%; P = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0–144.5) in patients with diabetes and 146.5 (95.8–163.0) in patients without diabetes (P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67–7.61; P value for interaction = 0.001). Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality.
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© 2024 by the American Thoracic Society.