Poor glycemic control may increase infection risk in diabetes patients
medwireNews: An analysis of the UK Clinical Practice Research Datalink indicates that elevated glycated hemoglobin (HbA1c) levels are associated with an increased risk for infection among patients with diabetes.
Julia Critchley (St George’s, University of London, UK) and colleagues observed “consistently higher rates” of infection between 2010 and 2015 among 85,312 patients with diabetes versus 153,341 matched controls without diabetes, with incidence rate ratios (IRRs) of 1.31 for any infection requiring a prescription, 1.78 for any infection resulting in hospitalization, and 2.44 for any resulting in death.
And there were “clear trends” for increasing infection risk with worsening glycemic control, say the researchers. For example, the IRR for infection requiring hospitalization relative to controls was 1.41 for patients with optimal glycemic control (mean HbA1c of 6 to <7%) in 2008–2009, rising to 1.58 for those with HbA1c levels of 7% to less than 8%, and 4.70 for those with the poorest degree of glycemic control (HbA1c≥11%).
When statistical models were applied to diabetes patients only, those with HbA1c levels of 11% or higher had an approximately threefold increased risk for infection requiring hospitalization or resulting in death versus patients with optimal HbA1c levels, with IRRs of 2.95 and 3.01, respectively, after adjustment for factors including age, smoking, BMI, and diabetes type.
The study authors estimate that a high percentage of serious infections could be avoided if patients had optimal glycemic control, with 46.0% of bone infections as well as 26.2% of endocarditis, 23.7% of tuberculosis, and 20.8% of sepsis cases attributed to poor glycemic control.
Critchley and team note that the association between poor glycemic control and infection risk was attenuated by age, with lower IRRs seen in patients aged 65 years or older compared with those aged 40–64 years. However, they say that “there were still clinically important increases in infection risks associated with poor control in the oldest age-groups where glycemic control can be more difficult and infection most common.”
They also demonstrated an association between diabetes type and infection risk, with type 1 diabetes patients having a larger risk increase relative to controls than type 2 diabetes patients (IRRs of 1.56 vs 1.29 for any infection requiring a prescription, and 3.34 vs 1.70 for infections resulting in hospitalization).
Together, these findings point to “a strong and likely causal association between hyperglycemia and infection risk” for type 1 and type 2 diabetes, and suggest that “[s]ubstantial proportions of serious infections can be attributed to poor control, even though [diabetes] is managed well in the U.K. by international standards,” write the researchers in Diabetes Care.
And they conclude that interventions aimed at reducing infection risk “should be a high priority for future research.”
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