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Patients with Diabetes Prone to Infections

Nov 12, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

Increased sugar in body tissues leads to more rapid growth of bacteria and makes people with diabetes prone to infections.

In an article written by J. L. Harding, PhD, in the Journal of Diabetes Care, the researcher shows that adults with diabetes have increased risk for infections.  This study compares adults with diabetes and without diabetes in their risks for influenza, cellulitis and sepsis infections.

A person’s body with diabetes has a lower ability to fight infection. Higher levels of glucose in the blood lead to higher sugar in the tissues of the body. This increased sugar in the tissue will allow bacteria to grow more rapidly. It is important to treat these infections rapidly to prevent more serious problems for adults with diabetes.

There are other sites of infections cited by other authors. These include: bladder, kidneys, vagina, gums, feet and skin. It is important that health care providers help adults with diabetes to take precautions to fight influenza infections by giving flu vaccinations.  Sepsis can be life-threatening and needs to be monitored for persons with diabetes and with an infection. Bladder infections known as UTI or urinary tract infections need to be managed before becoming too severe for adults with diabetes. Other types of infections include vaginal yeast infections, periodontal disease, and diabetic foot infections.  Cellulitis is a common and painful skin infection but can also spread to lymph nodes and the bloodstream. Health care providers need to be diligent in their care management of patients with diabetes who have these infections to avoid serious complications.

According to Harding, there are increasing numbers of people today living with diabetes.  This is expected to increase the number of persons with infections, and this will have a dynamic impact on hospitalization and patient care.  Harding says that it is important that health care providers increase their awareness of the risk for infection for adults with diabetes. This will help improve management of these patients in hospitals.

To show the impact of adults with and without diabetes in the United States, Harding and researchers used information from the National Health Interview Survey between 2000 and 2015.  The methodology used by the researchers found the number of hospitalizations with infections during this period of time. Then the researchers found data codes for patients with diabetes to make the comparison during the same period of time.

For the data accessing overall risk of infection, rates of hospitalization due to an infection were higher in adults with diabetes compared to adults without diabetes. Adults with diabetes saw higher rates in pneumonia, influenza, acute bronchitis and bronchiolitis, kidney infection, cellulitis, foot infections, osteomyelitis, mycoses, postoperative wound infections and sepsis. Infection rates in adults with diabetes who had an infection was 68.7 per 1,000 persons in 2015, which was up from 63.1 per 1,000 persons in 2000. In contrast, hospitalization rates due to infection in adults without diabetes were 16.3 per 1,000 persons in 2015 and 15.5 per 1,000 persons in 2000. A 7.9% decrease was noted in adults without diabetes after 2008.

The rate of hospitalization due to infection in adults with diabetes, aged 18 to 44 years, was 63.1 per 1,000 persons in 2015 compared with 42.1 per 1,000 persons (P < .0001). Among those with diabetes aged at least 75 years, the hospitalization infection rate was 131.7 per 1,000 persons in 2015 compared with 169.5 per 1,000 persons (P < .0001). There was no significant change in rates for adults with diabetes aged 65 to 74 years from 2000 to 2008.  For the same age range of 65 to 74 years, 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). Amongst the adults with diabetes aged 45 to 64 years, researchers concluded that the patterns of infections were generally similar.

In conclusion, there are several complications that can rise from diabetes and some can lead to hospitalization. Adults with diabetes had a higher rate of hospitalization for influenza, kidney infection, cellulitis, osteomyelitis and sepsis.  “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 in young adults,” said Nueffer.

Practice Pearls:

  • Diabetes patients are an increased risk of infections
  • Adults with diabetes are hospitalized from infections.
  • When blood sugars are elevated, it increases the risk for just about any infection.

Reference for “Patients with Diabetes Prone to Infections”:

Harding. “Diabetes Increases Risks for Certain Infections.” Healio, https://www.healio.com/endocrinology/diabetes/news/online/{8923c631-4038-4352-8cb5-0b202d08150d}/diabetes-increases-risks-for-certain-infections?M_BT=2469436429117.

Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate