{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:22:16Z","timestamp":1793640136107,"version":"4.5.1"},"reference-count":66,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes mellitus (DM) increases susceptibility to infection and worsens outcomes in sepsis, a leading cause of preventable death. However, population\u2010level trends in sepsis\u2010related mortality among diabetic individuals in the United States (US) remain poorly characterised, especially in the context of the COVID\u201019 pandemic. This study evaluates national patterns, temporal shifts, and demographic disparities in sepsis\u2010related mortality in diabetic patients from 1999 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide\u2010ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database. Sepsis\u2010related deaths with co\u2010listed DM were extracted for US adults between 1999 and 2023. Age\u2010adjusted mortality rates (AAMRs) were calculated and Joinpoint regression was used to estimate annual percentage changes (APCs) and identify significant trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 483,207 sepsis\u2010related deaths occurred in individuals with DM during the study period. AAMRs declined significantly from 1999 to 2018 (APC: \u22121.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), reversed sharply from 2018 to 2021 (APC: +18.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), and declined again through 2023 (APC: \u221212.25;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Mortality was highest among older adults (AAMR: 32.63), males (9.72 vs. 7.80 in females), and non\u2010Hispanic Black and American Indian\/Alaska Native populations (AAMRs: 17.94 and 17.92, respectively). Hispanic populations showed the steepest pandemic\u2010era increase (APC: +22.49) and subsequent decline (APC: \u221220.43). Rural areas consistently had higher AAMRs than urban areas (8.77 vs. 8.27), with sharper increases during the pandemic. State\u2010level disparities widened dramatically from 2021 to 2023, and regionally, the South and Midwest exhibited the highest and most persistent mortality burdens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sepsis\u2010related mortality in diabetic individuals in the US has undergone dynamic shifts over the past 25\u2009years, punctuated by COVID\u201019 era surges and shaped by deep\u2010rooted demographic, geographic, and structural inequities. These findings warrant integrated diabetes\u2010infection care models, early sepsis recognition, and equity\u2010driven interventions to reduce mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70082","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T18:43:49Z","timestamp":1753987429000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Trends and Disparities in Mortality due to Diabetes Mellitus and Sepsis in the US Adults: 1999\u20132023"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4197-2786","authenticated-orcid":false,"given":"Asad Gul","family":"Rao","sequence":"first","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9236-0822","authenticated-orcid":false,"given":"Sufyan","family":"Shahid","sequence":"additional","affiliation":[{"name":"Khawaja Muhammad Safdar Medical College  Sialkot Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1446-2268","authenticated-orcid":false,"given":"Neha","family":"Pervez","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9465-7502","authenticated-orcid":false,"given":"Ramsha","family":"Pervez","sequence":"additional","affiliation":[{"name":"Medical College Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2814-7314","authenticated-orcid":false,"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"CDC \u201cNational Diabetes Statistics Report \u201dDiabetes (2024) https:\/\/www.cdc.gov\/diabetes\/php\/data\u2010research\/index.html."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.2004"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573399815666191024085838"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","unstructured":"Trevelin SC Carlos D Beretta M da Silva JS Cunha FQ. 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