{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:20:16Z","timestamp":1790144416943,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DFG in the framework of the DFG Clinician Scientist Programme UMEA","award":["FU 356\/12-2"],"award-info":[{"award-number":["FU 356\/12-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Diabetes mellitus (DM) is a growing global health concern linked to increased hospitalization rates, longer hospital stays, and higher mortality. Older adults with DM are particularly prone to intracranial injuries due to frailty and DM-related complications such as neuropathy and cardiovascular diseases. This study explores the impact of DM on in-hospital outcomes in patients with intracranial injuries. Material and Methods: This retrospective cohort study used data from 45 hospitals in Germany, including 12,720 patients aged \u226540 years hospitalized between January 2019 and December 2023 with a primary diagnosis of intracranial injury. Patients were categorized based on the secondary presence of DM diagnosis (ICD-10 E10-E14). Outcomes included in-hospital mortality, rehospitalization within 1 year and hospital length of stay (LOS). Multivariable logistic regression models were used to analyze associations between DM and the different outcomes, adjusting for age, sex, hospitalization year, and comorbidities. Results: Among 12,720 patients, 2394 had a known DM diagnosis. The median age was higher in DM patients (82 vs. 79 years). In-hospital mortality rates were similar for patients with and without DM (4.7% vs. 4.6%; OR: 0.98; 95% CI: 0.78\u20131.22). DM was not associated with rehospitalization risk (OR: 1.06; 95% CI: 0.89\u20131.26) but showed a trend toward longer hospital stays (\u22657 days: OR: 1.13; 95% CI: 1.01\u20131.26). Conclusions: While DM did not significantly influence mortality or rehospitalization after intracranial injuries, it showed a non-significant trend towards extended LOS (\u22657 days). These findings underscore the importance of targeted management strategies to optimize outcomes in this population.<\/jats:p>","DOI":"10.3390\/medicina61122187","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:20:57Z","timestamp":1765369257000},"page":"2187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Nationwide Analysis of Diabetes Mellitus and Intracranial Injuries: No Impact on Mortality but Prolonged Hospital Stays in Germany"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2385-5200","authenticated-orcid":false,"given":"Theresia","family":"Sarabhai","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetology and Metabolism, Medical Faculty and University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"J\u00fcrgens","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopedics, Hospital Neuk\u00f6lln, 12351 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7227","authenticated-orcid":false,"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"Epidemiology, IQVIA, Unterschweinstiege, 60549 Frankfurt am Main, Germany"},{"name":"University Clinic, Philipps University, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2830","DOI":"10.1038\/s41591-024-03123-2","article-title":"The burden of diabetes-associated multiple long-term conditions on years of life spent and lost","volume":"30","author":"Gregg","year":"2024","journal-title":"Nat. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Teigland, T., Igland, J., Tell, G.S., Haltbakk, J., Graue, M., Fismen, A.S., Birkeland, K.I., \u00d8stbye, T., Peyrot, M., and Iversen, M.M. (2022). The prevalence and incidence of pharmacologically treated diabetes among older people receiving home care services in Norway 2009\u20132014: A nationwide longitudinal study. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-01068-6"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"Ong","year":"2023","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Freire, L.B., Brasil-Neto, J.P., da Silva, M.L., Miranda, M.G.C., Cruz, L.d.M., Martins, W.R., and Paz, L.P.d.S. (2024). Risk factors for falls in older adults with diabetes mellitus: Systematic review and meta-analysis. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04668-0"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"J\u00fcrgens, L., Sarabhai, T., and Kostev, K. (2024). In-Hospital Mortality Among Elderly Patients Hospitalized for Femur Fracture with and Without Diabetes Mellitus: A Multicenter Case-Control Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216484"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/17512433.2017.1293521","article-title":"Brain injury with diabetes mellitus: Evidence, mechanisms and treatment implications","volume":"10","author":"Hamed","year":"2017","journal-title":"Expert. Rev. Clin. Pharmacol."},{"key":"ref_8","first-page":"145","article-title":"Stress insulin resistance is a marker for mortality in traumatic brain injury","volume":"66","author":"Mowery","year":"2009","journal-title":"J. Trauma"},{"key":"ref_9","first-page":"1141","article-title":"Diabetic patients with traumatic brain injury: Insulin deficiency is associated with increased mortality","volume":"70","author":"Ley","year":"2011","journal-title":"J. Trauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s00068-015-0561-5","article-title":"Insulin-dependent diabetes and serious trauma","volume":"42","author":"Liou","year":"2016","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_11","first-page":"548","article-title":"Impact of Diabetic Hyperglycemia on Clinical Outcomes in Patients with Diabetes Mellitus Following Traumatic Brain Injury","volume":"33","author":"Tseng","year":"2023","journal-title":"Turk. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S2213-8587(19)30405-X","article-title":"Cerebral microvascular complications of type 2 diabetes: Stroke, cognitive dysfunction, and depression","volume":"8","author":"Sedaghat","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1007\/s11239-024-03036-4","article-title":"Mortality rate and factors associated with in-hospital mortality in patients hospitalized with pulmonary embolism in Germany","volume":"57","author":"Kostev","year":"2024","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kostev, K., Michalowsky, B., and Bohlken, J. (2024). In-Hospital Mortality in Patients with and without Dementia across Age Groups, Clinical Departments, and Primary Admission Diagnoses. Brain Sci., 14.","DOI":"10.3390\/brainsci14050455"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/00000658-198910000-00007","article-title":"Relationship between admission hyperglycemia and neurologic outcome of severely brain-injured patients","volume":"210","author":"Young","year":"1989","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Tsai, Y.-C., Wu, S.-C., Hsieh, T.-M., Liu, H.-T., Huang, C.-Y., Chou, S.-E., Su, W.-T., Hsu, S.-Y., and Hsieh, C.-H. (2020). Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124266"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71052","DOI":"10.18632\/oncotarget.11958","article-title":"Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor","volume":"7","author":"Shi","year":"2016","journal-title":"Oncotarget"},{"key":"ref_18","first-page":"131","article-title":"Early predictive factors on mortality in head injured patients: A retrospective analysis of 112 traumatic brain injured patients","volume":"56","author":"Prisco","year":"2012","journal-title":"J. Neurosurg. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rau, C.-S., Wu, S.-C., Chen, Y.-C., Chien, P.-C., Hsieh, H.-Y., Kuo, P.-J., and Hsieh, C.-H. (2017). Stress-Induced Hyperglycemia, but Not Diabetic Hyperglycemia, Is Associated with Higher Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14111340"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/TA.0000000000000716","article-title":"Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury","volume":"79","author":"Bosarge","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/00006123-200002000-00015","article-title":"The influence of hyperglycemia on neurological outcome in patients with severe head injury","volume":"46","author":"Rovlias","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/01.TA.0000135158.42242.B1","article-title":"The impact of hyperglycemia on patients with severe brain injury","volume":"58","author":"Jeremitsky","year":"2005","journal-title":"J. Trauma"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Teigland, T., Igland, J., Graue, M., Blytt, K.M., Haltbakk, J., Tell, G.S., Birkeland, K.I., \u00d8stbye, T., Kirkevold, M., and Iversen, M.M. (2024). Associations between diabetes and risk of short-term and long-term nursing home stays among older people receiving home care services: A nationwide registry study. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-05403-5"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kozio\u0142, M., Towpik, I., \u017burek, M., Niemczynowicz, J., Was\u0105\u017cnik, M., Sanchak, Y., Wierzba, W., Franek, E., and Walicka, M. (2021). Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions. J. Clin. Med., 10.","DOI":"10.3390\/jcm10245814"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rubens, M., Ramamoorthy, V., Saxena, A., McGranaghan, P., and McCormack-Granja, E. (2022). Recent Trends in Diabetes-Associated Hospitalizations in the United States. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226636"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0003-9993(99)90312-X","article-title":"Etiology and incidence of rehospitalization after traumatic brain injury: A multicenter analysis","volume":"80","author":"Cifu","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijso.2019.09.007","article-title":"A retrospective analysis of factors influencing readmission rates of acute traumatic subdural hematoma in the elderly: A cohort study","volume":"20","author":"Ho","year":"2019","journal-title":"Int. J. Surg. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e998","DOI":"10.1016\/j.wneu.2022.08.122","article-title":"Predictors of Extreme Hospital Length of Stay After Traumatic Brain Injury","volume":"167","author":"Yue","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3109\/02699052.2014.888769","article-title":"Admission glucose and coagulopathy occurrence in patients with traumatic brain injury","volume":"28","author":"Alexiou","year":"2014","journal-title":"Brain Inj."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13063-022-06005-5","article-title":"Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: Secondary analysis of a randomized trial","volume":"23","author":"Yuan","year":"2022","journal-title":"Trials"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.2337\/dc24-0469","article-title":"Excess Risk of Injury in Individuals with Type 1 or Type 2 Diabetes Compared with the General Population","volume":"47","author":"Feleke","year":"2024","journal-title":"Diabetes Care"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2187\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T13:00:08Z","timestamp":1765371608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122187"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122187","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}