Association between HbA1c Levels and Clinical Outcomes in Patients with Diabetes Mellitus and Melioidosis

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: 9.8-10.4). The composite outcome occurred in 74 (24.3%) patients, but it was not associated with HbA1c when analyzed by quartiles (P = 0.48) or as a continuous variable (P = 0.41). As in other studies, bacteremia remained the strongest factor associated with adverse outcomes (odds ratio: 9.68, 95% CI: 4.15-22.58, P <0.01). Unlike in other studies, age ≥50 years trended toward protection from death/ICU (P = 0.08). These data reflect continuing gaps in understanding the complex interplay of the immune system, DM, and melioidosis.