A significantly higher risk for bacterial infections was found among people with type 1 diabetes compared with those without diabetes, according to recent study findings published in BMJ Open Diabetes Research & Care.
“Earlier studies have shown an increased risk of bacterial infections in patients with diabetes; however, most of these studies have focused on specific pathogens or specific infection sites such as skin, urinary tract and respiratory infections or severe infection necessitating hospitalization,” the researchers wrote. “Consequently, the overall risk of infectious diseases in patients with diabetes, both severe infections and less severe infections treated outside of hospitals, has not been established.”
u Lehto, PhD, of Helsinki University Central Hospital in Finland, and colleagues evaluated patients with type 1 diabetes (n = 4,748) and age- and sex-matched controls without diabetes (n = 12,954) from a nationwide register with data on antibiotic drug prescription purchases and hospital discharge diagnoses between 1996 and 2009. Researchers sought to determine the rates of bacterial infections between the two groups. Urinary albumin excretion rate was used to classify diabetic nephropathy.
Overall, the patients with diabetes had 3,980 hospitalizations due to infections, 81.1% of which were bacterial, whereas controls had 2,882 hospitalizations due to infections, 72.9% of which were bacterial. Compared with controls, patients with diabetes had a higher hospitalization rate (RR = 2.3; 95% CI, 2.11-2.51). Between 1996 and 2009, there was a 4% annual increase in hospitalizations among patients with diabetes vs. a 3% annual decrease among controls. Comorbidities increased the risk for hospitalizations among both groups, with atherosclerosis having the greatest risk for both controls (RR = 3.09; 95% CI, 1.87-3.29) and patients with diabetes (RR = 3.16; 95% CI, 3.11-5.45).
Hospitalization rates increased with increasing severity of diabetic nephropathy; when compared with the normoalbuminuria group, the microalbuminuria group (RR = 1.23; 95% CI, 0.94-1.6), macroalbuminuria group (RR = 1.97; 95% CI, 1.49-2.61), dialysis group (RR = 11.2; 95% CI, 8.1-15.5) and the kidney transplantation group (RR = 6.72; 95% CI, 4.92-9.18) all had an increased risk for hospitalization.
Antibiotic purchases were greater among the patients with diabetes compared with controls (RR = 1.71; 95% CI, 1.65-1.77) and were more frequent in those with microalbuminuria (RR = 1.18; 95% CI, 1.07-1.3), macroalbuminuria (RR = 1.29; 95% CI, 1.15-1.44), dialysis (RR = 2.43; 95% CI, 2.08-2.84) and kidney transplantation (RR = 2.74; 95% CI, 2.35-3.17).
“Our study shows that bacterial infections are more frequent in patients with type 1 diabetes compared with age-matched and sex-matched [non-diabetic controls], both in hospital and outpatient settings,” the researchers wrote. “Although our study cannot ascertain whether bacterial infections lead to the development and progression of diabetic nephropathy, or if the nephropathy predisposes the patient to bacterial infections, it does show that there is a strong association between the two.” – by Amber Cox
Lehto reports various financial ties with the Diabetes Research Foundation, the Novo Nordisk Foundation and the Wilhelm and Else Stockmann Foundation. Please see the full study for a list of all other authors’ relevant financial disclosures.