Diabetes, Glycemic Control, and Risk of Hospitalization With Pneumonia

Abstract

OBJECTIVE -To examine whether diabetes is a risk factor for hospitalization with pneumonia and to assess the impact of A1C level on such risk. RESEARCH DESIGN AND METHODS-In this population-based, case-control study we identified patients with a first-time pneumonia-related hospitalization between 1997 and 2005, using health care databases in northern Denmark. For each case, 10 sex-and age-matched population control subjects were selected from Denmark's Civil Registration System. We used conditional logistic regression to compute relative risk (RR) for pneumonia-related hospitalization among subjects with and without diabetes, controlling for potential confounding factors.RESULTS -The study included 34,239 patients with a pneumonia-related hospitalization and 342,390 population control subjects. The adjusted RR for pneumonia-related hospitalization among subjects with diabetes was 1.26 (95% CI 1.21-1.31) compared with nondiabetic individuals. The adjusted RR was 4.43 (3.40 -5.77) for subjects with type 1 diabetes and 1.23 (1.19 -1.28) for subjects with type 2 diabetes. Diabetes duration Ն10 years increased the risk of a pneumonia-related hospitalization (1.37 [1.28 -1.47]). Compared with subjects without diabetes, the adjusted RR was 1.22 (1.14 -1.30) for diabetic subjects whose A1C level was Ͻ7% and 1.60 (1.44 -1.76) for diabetic subjects whose A1C level was Ն9%.CONCLUSIONS -Type 1 and type 2 diabetes are risk factors for a pneumonia-related hospitalization. Poor long-term glycemic control among patients with diabetes clearly increases the risk of hospitalization with pneumonia.

Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States

“…Studies have shown that obesity leads to impaired immune and lung function 47 , 48 , 49 . Obesity is also a risk factor for conditions that, in turn, increase risk of severe respiratory infection or severe outcomes, for example, hyperglycemia, obstructive sleep apnea, and aspiration associated with gastroesophageal reflux disease 50 , 51 , 52 . An association between obesity and influenza‐related hospitalizations may also be attributed to the increased risk of cardiovascular events following influenza infection 53 .…”

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

“…Nevertheless, the results of 2 studies contradict this finding. In a large population-based case-control study 19 and a cohort study, 20 the risk of pneumonia-related hospitalizations and deaths was increased in patients with type 2 diabetes.…”

Dysglycaemia and 90 day and 1 year risks of death or readmission in patients hospitalised for community-acquired pneumonia

“…Although single casual glucose levels of <11.1 mmol/l are within the 'normal' range [19], previous studies suggest that casual glucose levels >6.1 mmol/l are associated with adverse outcomes in CAP patients [11,12]. Thus, as have others [11,14,20], we classified participants a priori according to admission glucose levels into four levels of dysglycaemia: 4.0 to <6.1 mmol/l; 6.1 to <7.8 mmol/l; 7.8 to <11.1 mmol/l; and 11.1 to 20.0 mmol/l. Participants with admission glucose levels greater than 20 mmol/l or less than 4 mmol/l [19] were excluded (n=538) as such extreme glucose levels would mandate urgent hospital management, resulting in data inexorably confounded by treatment modality (i.e.…”

“…In a case-control study from Denmark, increasing dysglycaemia in patients with diabetes was associated with an increasing risk of admission for CAP, although the effects in CAP patients without diabetes were not assessed [14]. In the only other study, also from Denmark, dysglycaemia on admission for pneumonia was a strong predictor of 30 day mortality in both patients with and without diabetes [11].…”