Increased Risk of Common Infections in Patients with Type 1 and Type 2 Diabetes Mellitus

Muller, L M A J; Gorter, Kees J.; Hak, Eelko; Goudzwaard, W L; Schellevis, François G.; Hoepelman, Andy I. M.; Rutten, Guy E.H.M.

doi:10.1086/431587

Cited by 890 publications

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References 34 publications

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“…It was debated for some time whether diabetes leads to an increased risk of infections [22], but recent reports have shown that a number of different infections occur at an increased frequency among individuals with diabetes [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

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Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

2006

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Aims/hypothesis Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial. Materials and methods We studied 10,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression analysis. Results At baseline, 353 individuals reported having diabetes. During 71,509 person-years of follow-up, a total of 1,194 individuals were hospitalised because of an infection. The risk of pneumonia (adjusted hazard ratio [aHR] 1.75, 95% CI 1.23-2.48), urinary tract infection (aHR 3.03, 95% CI 2.04-4.49) and skin infection (aHR 2.43, 95% CI 1.49-3.95) was increased in subjects with diabetes compared with subjects without. Each 1 mmol/l increase in plasma glucose at baseline was associated with a 6-10% increased relative risk of pneumonia, urinary tract infection and skin infection after adjustment for other possible confounders. Among patients hospitalised for urinary tract infection, diabetic patients were at an increased risk of death at 28 days after admission compared with nondiabetic subjects (HR 3.90,. Conclusions/interpretation In the Danish general population, diabetes and hyperglycaemia are strong and independent risk factors for hospitalisation as a result of pneumonia, urinary tract infection and skin infection. Further, diabetes has a negative impact on the prognosis of urinary tract infection.

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Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus is associated with an increased risk of morbidity caused by infectious diseases [1][2][3][4][5]. Furthermore, diabetes is associated with an increased risk of death from infectious disease in some [1,2,6,7], but not all [8], studies.…”

Section: Introductionmentioning

confidence: 99%

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

2006

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“…The following demographics were selected : age and type of health insurance as a proxy for socioeconomic status [4]. Moreover, use of medication (insulin and/ or oral blood glucose lowering medication), healthcare use and possibly relevant comorbidity were selected.…”

Section: Potential Predictor Variablesmentioning

confidence: 99%

“…Because we only had data for 1 year, successive visits could have been defined as a first visit. The selected comorbidity was the same as that described in a previous study by our group [4]. In addition, the following diseases were recorded : depression, chronic alcohol abuse, hypertension, cerebrovascular disease, dementia and urinary incontinence.…”

Section: Potential Predictor Variablesmentioning

confidence: 99%

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A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care

et al. 2008

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SUMMARYWe aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged o45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia. In women, renal disease was an additional predictor. The optimum corrected area under the receiver-operating curve (AUC) was 0 . 79 (95 % CI 0 . 74-0 . 83) for women and 0 . 75 (95 % CI 0 . 70-0 . 80) for men. Using a cut-off score of 4, women with a lower risk assignment had a probability of 0 . 3 % for the outcome. For a cut-off score of 6, women with a higher risk assignment had a probability of 5 . 8 %. For men these figures were 0 . 8 and 7 . 1 for a cut-off score of 2 and 4, respectively. Simple variables can be used for the risk stratification of patients.

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Pneumonia in Older Adults

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2005

JAMA

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A new TNM staging strategy for nodepositive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg. 2002;236: 416-421. 8. Moertel CG, Fleming TR, Macdonald JS, et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990;322:352-358. 9. Moertel CG, Fleming TR, Macdonald JS, et al. Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes'B2 colon cancer. Abstract 982. 11. Jessup JM, Stewart A, Greene FL, Minsky BD. Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA. 2005; 294:2703-2711. 12. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA. 1990;264:1444-1450. 13. Laurie JA, Moertel CG, Fleming TR, et al; The North Central Cancer Treatment Group and the Mayo Clinic. Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. J Clin Oncol. 1989;7:1447-1456. 14. Brawley OW, Freeman HP. Race and outcomes: is this the end of the beginning for minority health research? J Natl Cancer Inst. 1999;91:1908-1909. 15. Bain BJ. Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol. 1996;49:664-666. 16. Hershman D, Weinberg M, Rosner Z, et al. Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. ,00 .asp. Accessed November 10, 2005. 21. Sargent D. Endpoints for colon adjuvant clinical trials: recommendations based on individual data from 20898 patients and 18 randomized trials [abstract]. J Clin Oncol. 2005;83:23. 22. Hershman D, McBride R, Jacobson JS, et al. Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol. 2005;23:6639-6646. 23. Gwyn K, Bondy ML, Cohen DS, et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer. 2004;100:1595-1604. 24. Westra JL, Schaapveld M, Hollema H, et al. Determination of TP53 mutation is more relevant than microsatellite instability status for the prediction of diseasefree survival in adjuvant-treated stage III colon cancer patients.

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Increased Risk of Common Infections in Patients with Type 1 and Type 2 Diabetes Mellitus

Abstract: Patients with DM1 and DM2 are at increased risk for lower respiratory tract infection, urinary tract infection, and skin and mucous membrane infection. Studies are warranted into management of such infections in patients with diabetes.

Cited by 890 publications

References 34 publications

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care

Pneumonia in Older Adults

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