Diabetes drives risk for infection-related hospitalization
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Data published in Diabetologia show diabetes confers a significant risk for infection-related hospitalization, suggesting a greater need for early treatment among people with diabetes to reduce infection-related morbidity and mortality.
“Serious infection-related complications are an underappreciated issue related to diabetes,” Michael Fang, PhD, assistant scientist in epidemiology at the Johns Hopkins Bloomberg School of Public Health, told Healio. “When providers think about diabetic complications, they traditionally think about microvascular issues or cardiovascular disease. Accordingly, clinical guidelines have largely focused on preventing and managing these conditions. However, our study shows that people with diabetes are also at significantly higher risk for serious infection-related complications, including hospitalization and death.”
In a prospective study, Fang and colleagues analyzed data from 12,379 adults aged 45 to 64 years participating in the ongoing Atherosclerosis Risk in Communities study (mean age, 55 years; 24.7% Black; 54.3% women). Participants were recruited from 1987 to 1989 for exams and medical interviews. Diabetes was defined as a fasting glucose of at least 7 mmol/L or nonfasting glucose of at least 11.1 mmol/L, self-report of a diagnosis of diabetes by a physician or current diabetes medication use. Researchers used hospital discharge records to assess rates of hospitalization. Participants were followed through 2019.
During a median follow-up of 23.8 years, there were 4,229 new hospitalizations for infection. After adjusting for potential confounders, people with diabetes at baseline had a higher risk for hospitalization for infection compared with those without diabetes (HR = 1.67; 95% CI, 1.52-1.83). Results were generally consistent across infection type, but the association was especially pronounced for foot infection, with an HR of 5.99 (95% CI, 4.38-8.19). Diabetes was more strongly associated with hospitalization for infection in younger participants and Black people.
Overall infection mortality was low at 362 deaths; however, the adjusted risk was increased for people with diabetes (HR = 1.72; 95% CI, 1.28-2.31).
“Diabetes guidelines should provide more comprehensive guidance on infection prevention and management,” Fang told Healio. “Currently, guidelines focus mostly on foot care and routine vaccinations, such as influenza. These are undoubtedly important, but there is a pressing need to more broadly understand how to prevent and manage infections effectively in people with diabetes, especially given the ongoing COVID-19 pandemic.”
Fang said more research is needed on why diabetes is associated with an increased risk for infection-related complications.
“One likely factor is glycemic control; emerging research suggests patients with diabetes with better glycemic control may be at significantly lower risk for infection-related complications,” Fang said. “More research is needed in this area, but addressing this question will be important in developing effective prevention strategies.”
For more information:
Michael Fang, PhD, can be reached at mfang9@jh.edu.
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