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Risk of Infection in Older Adults With Type 2 Diabetes With Relaxed Glycemic Control.

Kasia J Lipska1, Lisa K Gilliam2, Catherine Lee3

  • 1Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.

Diabetes Care
|October 22, 2024
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Summary

Older adults with type 2 diabetes and relaxed glycemic control (HbA1c 7-9%) generally face no increased infection hospitalization risk. However, HbA1c 8-9% is linked to higher skin infection hospitalization rates.

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Area of Science:

  • Gerontology
  • Endocrinology
  • Infectious Diseases

Background:

  • Type 2 diabetes management in older adults requires balancing glycemic control with potential risks.
  • Understanding infection hospitalization risks associated with different glycemic control targets is crucial for patient care.

Purpose of the Study:

  • To compare the risk of hospitalization for infections in older adults with type 2 diabetes based on intensive versus relaxed glycemic control.
  • To evaluate infection hospitalization risks across various infection types (respiratory, genitourinary, skin, soft tissue, bone, and sepsis).

Main Methods:

  • Retrospective cohort study of adults aged 65+ with type 2 diabetes.
  • Analysis of hospitalization data for infections comparing intensive (HbA1c 6% to <7%) with relaxed (HbA1c 7% to <8% and 8% to <9%) glycemic control.
  • Use of negative binomial models to estimate incidence rates and relative risk (RR).

Main Results:

  • Among 103,242 patients, the infection hospitalization rate was 51.3 per 1,000 person-years.
  • HbA1c 8% to <9% showed an elevated unadjusted risk of hospitalization for infections (RR 1.25), which became nonsignificant after adjustment.
  • An increased adjusted RR of hospitalization was observed for skin, soft tissue, and bone infections in the HbA1c 8% to <9% group (RR 1.33).

Conclusions:

  • Relaxed glycemic control levels (HbA1c 7% to <8%) are not associated with a significantly increased risk of infection hospitalization in older adults with type 2 diabetes.
  • HbA1c levels of 8% to <9% are associated with an increased risk of hospitalization specifically for skin, soft tissue, and bone infections.
  • Clinical guidelines for relaxed glycemic control in older diabetic patients appear safe regarding most infection-related hospitalizations.