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Diabetes Mellitus and Infectious Diseases: Current Evidence and Clinical Implications
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Abstract:
Diabetes mellitus predisposes individuals to a broad spectrum of infections. People with diabetes face a 1.5- to 4-fold increased risk of both common and severe infections, and infections remain the leading cause of morbidity and mortality. Chronic hyperglycemia impairs neutrophil chemotaxis, oxidative burst, and complement activation, while vascular insufficiency and neuropathy compromise tissue perfusion and barrier integrity. These defects, together with altered skin, mucosal, and gut microbiota, influence the marked susceptibility to urinary tract infections (especially renal abscess and emphysematous pyelonephritis), osteomyelitis, diabetic foot infections, pneumonia (including influenza), tuberculosis, skin and soft tissue infections, and lifethreatening syndromes such as emphysematous cholecystitis and rhino-orbital mucormycosis that are almost exclusive to people with diabetes. Outcomes from infections are worse in diabetes. Although the core therapeutic principles align with those for patients without diabetes, management should be individualized. Glycemic control should balance infection risk and hypoglycemia; antimicrobial dosing should account for renal function and drug interactions; and strict antimicrobial stewardship is required. If needed, prompt debridement and multidisciplinary intervention are necessary to mitigate complications and reduce mortality. Preventive care relies on comprehensive vaccination (influenza, pneumococcus, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], hepatitis B, herpes zoster, and Tdap/Td) and regular foot surveillance with offloading to avert ulceration.
Insights
Diabetes significantly increases infection risk and severity due to impaired immunity and vascular issues. Effective management requires individualized treatment, strict antimicrobial stewardship, and preventive care, including vaccinations and foot surveillance.
Area of Science:
- Infectious Diseases
- Endocrinology
- Immunology
Background:
- Diabetes mellitus elevates infection risk by 1.5- to 4-fold, contributing significantly to morbidity and mortality.
- Chronic hyperglycemia impairs immune functions like neutrophil chemotaxis and oxidative burst, alongside vascular and neurological deficits, increasing susceptibility.
Purpose of the Study:
- To review the spectrum of infections in diabetes mellitus.
- To discuss the mechanisms underlying increased infection susceptibility in diabetic individuals.
- To outline optimal management and preventive strategies for infections in diabetes.
Main Methods:
- Literature review of studies on diabetes and infection.
- Analysis of immune and vascular mechanisms contributing to infection risk.
- Synthesis of current guidelines for infection management and prevention in diabetes.
Main Results:
- Diabetic individuals are prone to specific infections including UTIs, osteomyelitis, diabetic foot infections, pneumonia, and life-threatening conditions like emphysematous cholecystitis.
- Infections in diabetes have worse outcomes compared to non-diabetic individuals.
- Individualized management focusing on glycemic control, appropriate antimicrobial dosing, and prompt intervention is crucial.
Conclusions:
- Diabetes mellitus presents a complex challenge due to increased susceptibility and severity of infections.
- Comprehensive management involves balancing glycemic control with infection risk, optimizing antimicrobial therapy, and implementing preventive measures.
- Vaccination and regular foot surveillance are key components of preventive care to reduce infection-related complications and mortality.
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