Risks of Developing Diabetes and Hyperglycemic Crisis Following Carbon Monoxide Poisoning: A Study Incorporating Epidemiologic Analysis and Animal Experiment

Chien-Cheng Huang; Tzu-Hao Chen; Chung-Han Ho; Yi-Chen Chen; Rong-Jane Chen; Ying-Jan Wang; Chien-Chin Hsu; Hung-Jung Lin; Jhi-Joung Wang; Ching-Ping Chang; How-Ran Guo

doi:10.2147/CLEP.S380990

Risks of Developing Diabetes and Hyperglycemic Crisis Following Carbon Monoxide Poisoning: A Study Incorporating Epidemiologic Analysis and Animal Experiment

Clin Epidemiol. 2022 Nov 1:14:1265-1279. doi: 10.2147/CLEP.S380990. eCollection 2022.

Authors

Chien-Cheng Huang^{1

2

3}, Tzu-Hao Chen^{3

4}, Chung-Han Ho^{4

5}, Yi-Chen Chen⁴, Rong-Jane Chen^{3

6}, Ying-Jan Wang³, Chien-Chin Hsu¹, Hung-Jung Lin^{1

7}, Jhi-Joung Wang^{8

9}, Ching-Ping Chang⁴, How-Ran Guo^{3

10

11}

Affiliations

¹ Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
² Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
⁵ Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
⁶ Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁹ Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan.
¹⁰ Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
¹¹ Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan.

Abstract

Purpose: Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues.

Methods: Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning.

Results: Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18-1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52-2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus.

Conclusion: Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments.

Keywords: animal; carbon monoxide poisoning; diabetes; epidemiology; hypothalamus; pancreas.

Grants and funding

This study was supported by Grant MOHW108-TDU-B-212-124014 from the Ministry of Health and Welfare, Taiwan R.O.C. using surcharge of tobacco products, Grants MOST 111-2314-B-384-007, MOST 111-2314-B-006-031-MY3, MOST 109-2314-B-384-005-MY3 and MOST 108-2238-B-006-001-MY2 from the Ministry of Science and Technology, Taiwan, R.O.C., and Grant Physician-Scientist 11001 from the Chi Mei Medical Center.