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Glycemic Control and Risk of Infections Among People With Type 1 or Type 2 Diabetes in a Large Primary Care Cohort
Julia A Critchley1, Iain M Carey2, Tess Harris2
1Population Health Research Institute, St George's, University of London, London, U.K. jcritchl@sgul.ac.uk.
Diabetes Care
|August 15, 2018
Summary
Poor glycemic control in diabetes mellitus significantly elevates infection risk, especially for serious conditions. Achieving optimal blood sugar control is crucial for reducing infection-related hospitalizations and mortality.
Area of Science:
- Endocrinology
- Infectious Diseases
- Public Health
Background:
- Diabetes mellitus (DM) is a known risk factor for infections.
- The impact of glycemic control on infection risk in DM patients requires further investigation.
- Understanding this relationship is vital for public health strategies and patient management.
Purpose of the Study:
- To investigate the association between glycemic control (HbA1c levels) and infection risk in patients with diabetes mellitus.
- To compare infection rates in DM patients with varying glycemic control levels against individuals without DM.
- To quantify the attributable risk of poor glycemic control for specific infection categories and outcomes.
Main Methods:
- Utilized English primary care data for 85,312 DM patients (ages 40-89) to estimate average HbA1c (2008-2009).
- Compiled infection rates (2010-2015) from primary care, hospital, and mortality records across 18 categories.
- Employed Poisson regression to calculate incidence rate ratios (IRRs) comparing DM patients with controls and across HbA1c categories; calculated attributable fractions (AF%).
Main Results:
- Increased HbA1c levels correlated with higher long-term infection risk for most outcomes.
- Patients with DM and poor glycemic control (HbA1c ≥11%) showed significantly elevated hospitalization risks for infection compared to those without DM (IRR 4.70).
- Poor control in type 1 DM patients demonstrated an even greater risk of infection-related hospitalization (IRR 8.47); high AF% for serious infections like bone/joint infections and sepsis were observed.
Conclusions:
- Poor glycemic control is strongly linked to an increased risk of serious infections in diabetes mellitus patients.
- Maintaining optimal glycemic control (HbA1c 6-7%) is essential for mitigating infection risks.
- Addressing poor glycemic control should be a high priority in managing diabetes to prevent severe infectious complications.
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