{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:16:01Z","timestamp":1778084161436,"version":"3.51.4"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Diabetes mellitus (DM) is the major clinical risk factor for melioidosis, though the effect of improved glycemic control on clinical outcomes is unknown. We investigated whether glycemic control affects clinical outcomes by analyzing a composite outcome of death or intensive care unit admission among patients from the Darwin Prospective Melioidosis Study, stratified by their glycosylated hemoglobin (HbA1c). A total of 292 patients with melioidosis and DM were identified with mean HbA1c of 10.2% (95% CI: 9.8\u201310.4). The composite outcome occurred in 74 (24.3%) patients, but it was not associated with HbA1c when analyzed by quartiles (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.48) or as a continuous variable (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.41). As in other studies, bacteremia remained the strongest factor associated with adverse outcomes (odds ratio: 9.68, 95% CI: 4.15\u201322.58,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01). Unlike in other studies, age \u226550 years trended toward protection from death\/ICU (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.08). These data reflect continuing gaps in understanding the complex interplay of the immune system, DM, and melioidosis.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0454","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:12:27Z","timestamp":1773760347000},"page":"844-847","source":"Crossref","is-referenced-by-count":0,"title":["Association between HbA1c Levels and Clinical Outcomes in Patients with Diabetes Mellitus and Melioidosis"],"prefix":"10.4269","volume":"114","author":[{"given":"Sam","family":"Guempel-Crothers","sequence":"first","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"},{"name":"Northern Territory Medical Program, Flinders University, Royal Darwin Hospital, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Campbell","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Royal Darwin Hospital, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Kaestli","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celeste","family":"Woerle","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Mayo","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ella M.","family":"Meumann","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"},{"name":"Infectious Diseases Department, Royal Darwin Hospital, Darwin, Australia;"},{"name":"Microbiology Department, Territory Pathology, Darwin, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart J.","family":"Currie","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"},{"name":"Northern Territory Medical Program, Flinders University, Royal Darwin Hospital, Darwin, Australia;"},{"name":"Infectious Diseases Department, Royal Darwin Hospital, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"892","article-title":"Global burden of melioidosis in 2015: A systematic review and data synthesis","volume":"19","author":"Birnie","year":"2019"},{"key":"b2","series-title":"Nat Rev Microbiol","first-page":"155","article-title":"Burkholderia pseudomallei and melioidosis","volume":"22","author":"Meumann","year":"2024"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"1737","article-title":"The Darwin Prospective Melioidosis Study: A 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021"},{"key":"b4","series-title":"Trans R Soc Trop Med Hyg","first-page":"S37","article-title":"Intensity of exposure and incidence of melioidosis in Thai children","volume":"102","author":"Cheng","year":"2008"},{"key":"b5","series-title":"Pathogens","first-page":"149","article-title":"The epidemiology of melioidosis and its association with diabetes mellitus: A systematic review and meta-analysis","volume":"11","author":"Chowdhury","year":"2022"},{"key":"b6","series-title":"Acta Trop","first-page":"107559","article-title":"Melioidosis in people living with diabetes; Clinical presentation, clinical course and implications for patient management","volume":"263","author":"Prideaux","year":"2025"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"408","article-title":"Risk factors for melioidosis and Bacteremic melioidosis","volume":"29","author":"Suputtamongkol","year":"1999"},{"key":"b8","series-title":"Lancet Reg Health Southeast Asia","first-page":"100118","article-title":"Characteristics and one year outcomes of melioidosis patients in Northeastern Thailand: A prospective, multicenter cohort study","volume":"9","author":"Chantratita","year":"2023"},{"key":"b9","article-title":"Australian Diabetes Society Position Statement: Individualization of HbA1c Targets for Adults with Diabetes Mellitus.","author":"Cheung","year":"2009"},{"key":"b10","series-title":"PLoS Med","first-page":"e152","article-title":"Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies","volume":"5","author":"Jeon","year":"2008"},{"key":"b11","series-title":"Trop Med Int Health","first-page":"1167","article-title":"Melioidosis epidemiology and risk factors from a prospective whole-population study in northern Australia","volume":"9","author":"Currie","year":"2004"},{"key":"b12","series-title":"Microbes Infect","first-page":"1177","article-title":"Altered macrophage function is associated with severe Burkholderia pseudomallei infection in a murine model of type 2 diabetes","volume":"13","author":"Hodgson","year":"2011"},{"key":"b13","series-title":"Infect Immun","first-page":"2089","article-title":"Burkholderia pseudomallei triggers altered inflammatory profiles in a whole-blood model of type 2 diabetes-melioidosis comorbidity","volume":"80","author":"Morris","year":"2012"},{"key":"b14","series-title":"Chest","first-page":"1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis","volume":"101","author":"Bone","year":"1992"},{"key":"b15","series-title":"Eur J Immunol","first-page":"1092","article-title":"Diabetes alters immune response patterns to acute melioidosis in humans","volume":"49","author":"Kronsteiner","year":"2019"},{"key":"b16","series-title":"Pathogens","first-page":"165","article-title":"Clinical implications of high melioidosis serology indirect haemagglutination assay titre: A 20-year retrospective study from the top end of the Northern Territory, Australia","volume":"14:","author":"Ho","year":"2025"},{"key":"b17","series-title":"Am J Trop Med Hyg","first-page":"1378","article-title":"Antibodies in melioidosis: The role of the indirect hemagglutination assay in evaluating patients and exposed populations","volume":"99","author":"Chaichana","year":"2018"},{"key":"b18","series-title":"Clin Infect Dis","first-page":"717","article-title":"Glyburide is anti-inflammatory and associated with reduced mortality in melioidosis","volume":"52","author":"Koh","year":"2011"},{"key":"b19","series-title":"PLoS Negl Trop Dis","first-page":"e2795","article-title":"Sulphonylurea usage in melioidosis is associated with severe disease and suppressed immune response","volume":"8","author":"Liu","year":"2014"},{"key":"b1","series-title":"Lancet Infect Dis","first-page":"892","article-title":"Global burden of melioidosis in 2015: A systematic review and data synthesis","volume":"19","author":"Birnie","year":"2019"},{"key":"b2","series-title":"Nat Rev Microbiol","first-page":"155","article-title":"Burkholderia pseudomallei and melioidosis","volume":"22","author":"Meumann","year":"2024"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"1737","article-title":"The Darwin Prospective Melioidosis Study: A 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021"},{"key":"b4","series-title":"Trans R Soc Trop Med Hyg","first-page":"S37","article-title":"Intensity of exposure and incidence of melioidosis in Thai children","volume":"102","author":"Cheng","year":"2008"},{"key":"b5","series-title":"Pathogens","first-page":"149","article-title":"The epidemiology of melioidosis and its association with diabetes mellitus: A systematic review and meta-analysis","volume":"11","author":"Chowdhury","year":"2022"},{"key":"b6","series-title":"Acta Trop","first-page":"107559","article-title":"Melioidosis in people living with diabetes; Clinical presentation, clinical course and implications for patient management","volume":"263","author":"Prideaux","year":"2025"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"408","article-title":"Risk factors for melioidosis and Bacteremic melioidosis","volume":"29","author":"Suputtamongkol","year":"1999"},{"key":"b8","series-title":"Lancet Reg Health Southeast Asia","first-page":"100118","article-title":"Characteristics and one year outcomes of melioidosis patients in Northeastern Thailand: A prospective, multicenter cohort study","volume":"9","author":"Chantratita","year":"2023"},{"key":"b9","article-title":"Australian Diabetes Society Position Statement: Individualization of HbA1c Targets for Adults with Diabetes Mellitus.","author":"Cheung","year":"2009"},{"key":"b10","series-title":"PLoS Med","first-page":"e152","article-title":"Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies","volume":"5","author":"Jeon","year":"2008"},{"key":"b11","series-title":"Trop Med Int Health","first-page":"1167","article-title":"Melioidosis epidemiology and risk factors from a prospective whole-population study in northern Australia","volume":"9","author":"Currie","year":"2004"},{"key":"b12","series-title":"Microbes Infect","first-page":"1177","article-title":"Altered macrophage function is associated with severe Burkholderia pseudomallei infection in a murine model of type 2 diabetes","volume":"13","author":"Hodgson","year":"2011"},{"key":"b13","series-title":"Infect Immun","first-page":"2089","article-title":"Burkholderia pseudomallei triggers altered inflammatory profiles in a whole-blood model of type 2 diabetes-melioidosis comorbidity","volume":"80","author":"Morris","year":"2012"},{"key":"b14","series-title":"Chest","first-page":"1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis","volume":"101","author":"Bone","year":"1992"},{"key":"b15","series-title":"Eur J Immunol","first-page":"1092","article-title":"Diabetes alters immune response patterns to acute melioidosis in humans","volume":"49","author":"Kronsteiner","year":"2019"},{"key":"b16","series-title":"Pathogens","first-page":"165","article-title":"Clinical implications of high melioidosis serology indirect haemagglutination assay titre: A 20-year retrospective study from the top end of the Northern Territory, Australia","volume":"14:","author":"Ho","year":"2025"},{"key":"b17","series-title":"Am J Trop Med Hyg","first-page":"1378","article-title":"Antibodies in melioidosis: The role of the indirect hemagglutination assay in evaluating patients and exposed populations","volume":"99","author":"Chaichana","year":"2018"},{"key":"b18","series-title":"Clin Infect Dis","first-page":"717","article-title":"Glyburide is anti-inflammatory and associated with reduced mortality in melioidosis","volume":"52","author":"Koh","year":"2011"},{"key":"b19","series-title":"PLoS Negl Trop Dis","first-page":"e2795","article-title":"Sulphonylurea usage in melioidosis is associated with severe disease and suppressed immune response","volume":"8","author":"Liu","year":"2014"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p844.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p844.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p844.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T15:37:49Z","timestamp":1778081869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p844.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":38,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0454","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]}}}