Increased Risk Of Hospitalization For Infection Seen With Diabetic Patients

Does diabetes increase a patient’s risk for being hospitalized for infections compared to non-diabetics?

Increase risk of common and rare infections are associated with patients living with diabetes. There is general reasoning that patients with diabetes are susceptible to infection because of impaired neutrophil functioning, antioxidant systems, and humoral immune response. There is more focus on diabetes management of micro- and macrovascular complications and less attention given to infectious diseases. The rate of hospitalizations from infections increased significantly in patients living with diabetes from 2000 to 2015. Diabetes is associated with adverse outcomes in patients affected by the coronavirus disease-2019 (COVID-19) pandemic. Diabetes may also be a risk factor for infection from severe acute respiratory syndrome coronavirus- (SARS-CoV-2). There are not many studies that look at the link between diabetes and future risk of infections. This study wants to examine data from the Atherosclerosis Risk in Communities (ARIC) study to assess the association between diabetes and risk of infections and mortality due to infections.

The ARIC study consisted of 15,792 participants between 45 to 65 years old from 4 communities across America. Clinical examinations, medical interviews, and laboratory tests were collected when patients were recruited in 1987-1989. From 1990 to 2019, there were seven subsequent study visits. Of the 15,792 participants in the ARIC, this study assesses data from 12,379 after excluding participants who did not meet the study’s criteria.

Diabetes diagnosed by a physician was self-reported by participants on the first study visit. Participants also brought all their prescription medication used over the prior two weeks and tested their blood sugar using the hexokinase method. The study could not distinguish between type 1 and type 2 diabetes because antibody tests were not available.

Diagnostic codes assessed the first Hospitalization for infection from hospital discharge records. The codes were ICD-9-CM/ICD-10-CM. ICD-9-CM/ICD-10-CM defined infection mortality as the underlying cause of death on the death certificates. To collect baseline demographic information and health behaviors, the researcher used a questionnaire. A t-test or X² test assesses differences between study groups. Poisson models with robust error variance were used to estimate the age-adjusted hospitalization rate for infection and infection mortality. A Cox proportional hazard model was used to determine the associations between diabetes and the risk of Hospitalization. The Wald test examined the potential effect modification by age, sex, race, SES, health insurance status, and obesity would have. The risk of Hospitalization for infection with diabetes is measured as a time-varying exposure. The Fine-Gray model was used to assess the link between diabetes and Hospitalization while accounting for the competing risk of death.

The study reported that participants with diabetes at baseline tended to be older, low SES, Black, and worse cardiometabolic health. AT the end of the 4229 of 12,379 were hospitalized for infections. Patients with diabetes had a greater risk for Hospitalization for infections than those without diabetes. Non- diabetes had a 15.2 per 1000 person-year risk, while diabetes had 25.4 per 1000 person-year risk. Black participants and younger participants had an increased risk of being hospitalized for infection associated with diabetes. A similar association was seen between diabetes and incident hospitalizations after competing for risk of death is taken into account. There was a high risk for Hospitalization for nearly every type of infection in patients with diabetes than for non-diabetes, with foot infection standing out compared to other infections. Infections were listed as the underlying cause of death for 362 of the participants.

Diabetes significantly increases the risk of Hospitalization for infection and infection mortality. Persons living with diabetes are at increased risk of Hospitalization for infections across all major types of infections, especially for foot infections. As a result of this, broader guidance on infection prevention and management needs to be developed. Recommendation for prevention and treatment for infections is critical now because COVID 19 and the rising rates of Hospitalization for infections affect people with diabetes the most.  For patients to reduce infection-related morbidity and mortality, early treatment of infections and enhanced prevention is needed.  Obtaining and maintaining glycemic control may also be important aspects in the prevention and management of infections.

• Diabetes increases patients risk of Hospitalization for infection in all the major types of infection
• To reduce morbidity and mortality, enhanced prevention and early treatment of infection are necessary.
• Younger persons and Black people have a higher incidence of Hospitalization for infection.

Fang, Michael et al. “Diabetes and the risk of hospitalisation for infection: the Atherosclerosis Risk in Communities (ARIC) study.” Diabetologia, 1–8. 4 Aug. 2021, doi:10.1007/s00125-021-05522-3

Author: Jerrine Fletcher, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health