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Author: Bailey, Michael ; Brickell, Kathy ; Sivasuthan, Janani ; Tipping, Claire J. ; Gould, Doug W. ; Higgins, Alisa M. ; Zoungas, Sophia ; Harrold, Meg ; Young, Paul J. ; Broadley, Tessa ; Buhr, Heidi ; Presneill, Jeffrey J. ; Poole, Alex ; Nichol, Alistair D. ; Webb, Steven ; Iwashyna, Theodore J. ; Bellomo, Rinaldo ; Hurford, Sally ; Schaller, Stefan J. ; Serpa Neto, Ary ; Agli, Alicia ; Bradley, Scott ; Parke, Rachael ; Hodgson, Carol L. ; Gabbe, Belinda J. ; Seller, Daniel

Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status. Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0-153] vs. 147 [82-164]; P = 0.013) and higher 180-day mortality (30% vs. 18%; P = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0-144.5) in patients with diabetes and 146.5 (95.8-163.0) in patients without diabetes (P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67-7.61; P value for interaction = 0.001). Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality.

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