In the Journals

Diabetes increases risks for certain infections

Adults with diabetes have increased risks for infections, such as influenza, cellulitis and sepsis, compared with adults without diabetes, according to findings published in Diabetes Care.

“The increasing number of persons living with diabetes is likely to increase the number of persons with infections in the future and will have important implications for hospital burden and patient care,” Jessica L. Harding, PhD, of the division of diabetes translation at the CDC, and colleagues wrote. “Improved awareness by health care providers that diabetes is an important risk factor for infection might improve management.”

Harding and colleagues estimated the number of adults with and without diabetes in the United States between 2000 and 2015 based on information from the National Health Interview Survey. The researchers also identified the number of hospitalizations due to infections across the same period based on data and diagnosis codes from the National Inpatient Sample. Infection diagnosis codes that were combined with a diabetes diagnosis code were “considered to be related to diabetes.”

Overall infection risk

Compared with adults without diabetes, adults with diabetes had a higher rate of hospitalization due to an infection (rate ratio [RR] = 3.8; 95% CI, 3.8-3.8). In addition, when compared with adults without diabetes, adults with diabetes had higher rates for pneumonia (RR = 2.6; 95% CI, 2.6-2.6), influenza (RR = 3.3; 95% CI, 3.3-3.4), acute bronchitis and bronchiolitis (RR = 3.7; 95% CI, 3.7-3.8), kidney infection (RR = 4.3; 95% CI, 4.3-4.4), cellulitis (RR = 6.9; 95% CI, 6.9-6.9), foot infections (RR = 14.7; 95% CI, 14.6-14.8), osteomyelitis (RR = 15.7; 95% CI, 15.5-15.8), mycoses (RR = 2.8; 95% CI, 2.8-2.8), postoperative wound infections (RR = 3.2; 95% CI, 3.2-3.2) and sepsis (RR = 3.2; 95% CI, 3.2-3.2).

Diabetes Words 2019 
Adults with diabetes have increased risks for infections, such as influenza, cellulitis and sepsis, compared with adults without diabetes.
Source: Adobe Stock

The researchers also found that adults with diabetes had a hospitalization rate due to infection of 68.7 per 1,000 persons in 2015, which was up from 63.1 per 1,000 persons in 2000. By contrast, adults without diabetes had hospitalization rates due to infection of 16.3 per 1,000 persons in 2015 and 15.5 per 1,000 persons in 2000. The researchers noted that there was a significant 7.9% decrease in this rate for adults without diabetes after 2008 but no decrease for those with diabetes.

Differences by age group, infection type

The researchers also wrote that influenza, kidney infection, cellulitis, osteomyelitis and sepsis rates rose when comparing 2015 with 2000, whereas postoperative wound infections and acute bronchitis or bronchiolitis rates fell during this period.

The rate of hospitalization due to infection was 63.1 per 1,000 persons in 2015 compared with 42.1 per 1,000 persons among adults with diabetes aged 18 to 44 years (P < .0001). The hospitalization infection rate was 131.7 per 1,000 persons in 2015 compared with 169.5 per 1,000 persons among those with diabetes aged at least 75 years (P < .0001). The researchers wrote that from 2000 to 2008, there was “no significant change in rates” for adults with diabetes aged 65 to 74 years, but the rate for hospitalization due to an infection was 72.9 per 1,000 persons in 2015 compared with 88.9 per 1,000 persons in 2008 (P < .001). In addition, the researchers noted that rates did not change among adults with diabetes aged 45 to 64 years and that “patterns by infection type among people with diabetes were generally similar.”

“Collectively, our findings suggest greater public health and medical initiatives are required to prevent infections requiring hospitalization in adults with diabetes,” the researchers wrote. “This study highlights the need for greater infectious risk factor mitigation in adults with diabetes, especially young adults with diabetes.” – by Phil Neuffer

Disclosures: Harding reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Adults with diabetes have increased risks for infections, such as influenza, cellulitis and sepsis, compared with adults without diabetes, according to findings published in Diabetes Care.

“The increasing number of persons living with diabetes is likely to increase the number of persons with infections in the future and will have important implications for hospital burden and patient care,” Jessica L. Harding, PhD, of the division of diabetes translation at the CDC, and colleagues wrote. “Improved awareness by health care providers that diabetes is an important risk factor for infection might improve management.”

Harding and colleagues estimated the number of adults with and without diabetes in the United States between 2000 and 2015 based on information from the National Health Interview Survey. The researchers also identified the number of hospitalizations due to infections across the same period based on data and diagnosis codes from the National Inpatient Sample. Infection diagnosis codes that were combined with a diabetes diagnosis code were “considered to be related to diabetes.”

Overall infection risk

Compared with adults without diabetes, adults with diabetes had a higher rate of hospitalization due to an infection (rate ratio [RR] = 3.8; 95% CI, 3.8-3.8). In addition, when compared with adults without diabetes, adults with diabetes had higher rates for pneumonia (RR = 2.6; 95% CI, 2.6-2.6), influenza (RR = 3.3; 95% CI, 3.3-3.4), acute bronchitis and bronchiolitis (RR = 3.7; 95% CI, 3.7-3.8), kidney infection (RR = 4.3; 95% CI, 4.3-4.4), cellulitis (RR = 6.9; 95% CI, 6.9-6.9), foot infections (RR = 14.7; 95% CI, 14.6-14.8), osteomyelitis (RR = 15.7; 95% CI, 15.5-15.8), mycoses (RR = 2.8; 95% CI, 2.8-2.8), postoperative wound infections (RR = 3.2; 95% CI, 3.2-3.2) and sepsis (RR = 3.2; 95% CI, 3.2-3.2).

Diabetes Words 2019 
Adults with diabetes have increased risks for infections, such as influenza, cellulitis and sepsis, compared with adults without diabetes.
Source: Adobe Stock

The researchers also found that adults with diabetes had a hospitalization rate due to infection of 68.7 per 1,000 persons in 2015, which was up from 63.1 per 1,000 persons in 2000. By contrast, adults without diabetes had hospitalization rates due to infection of 16.3 per 1,000 persons in 2015 and 15.5 per 1,000 persons in 2000. The researchers noted that there was a significant 7.9% decrease in this rate for adults without diabetes after 2008 but no decrease for those with diabetes.

Differences by age group, infection type

The researchers also wrote that influenza, kidney infection, cellulitis, osteomyelitis and sepsis rates rose when comparing 2015 with 2000, whereas postoperative wound infections and acute bronchitis or bronchiolitis rates fell during this period.

The rate of hospitalization due to infection was 63.1 per 1,000 persons in 2015 compared with 42.1 per 1,000 persons among adults with diabetes aged 18 to 44 years (P < .0001). The hospitalization infection rate was 131.7 per 1,000 persons in 2015 compared with 169.5 per 1,000 persons among those with diabetes aged at least 75 years (P < .0001). The researchers wrote that from 2000 to 2008, there was “no significant change in rates” for adults with diabetes aged 65 to 74 years, but the rate for hospitalization due to an infection was 72.9 per 1,000 persons in 2015 compared with 88.9 per 1,000 persons in 2008 (P < .001). In addition, the researchers noted that rates did not change among adults with diabetes aged 45 to 64 years and that “patterns by infection type among people with diabetes were generally similar.”

“Collectively, our findings suggest greater public health and medical initiatives are required to prevent infections requiring hospitalization in adults with diabetes,” the researchers wrote. “This study highlights the need for greater infectious risk factor mitigation in adults with diabetes, especially young adults with diabetes.” – by Phil Neuffer

Disclosures: Harding reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.