Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

Abstract

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.

Type, course and outcome of community acquired infections in hospitalized diabetics

“…S. aureus has proven to be the most frequent isolated pathogen in another recent study, causing 63% of soft tissue infections, whereas skin infections were increased in diabetic patients compared with non-diabetics in a Danish general population who participated in the Copenhagen City Heart Study. 32,33 Moreover, apart from skin infection (one case) in our study Streptococcus was found responsible for 2 pneumonia cases among diabetics. Regarding group B streptococcus infections, Skoff and colleagues found that patients with diabetes were more likely to present with skin and/or soft tissue infections and pneumonia, and that diabetes was present in 44.4% of all cases, whereas in another study, Schwartz and colleagues observed a 10.5-fold increase in risk of group B streptococcus infections in diabetics.…”

Influence of diabetes on endothelial cell response during sepsis

“…Diabetes is a major comorbid condition in septic patients because of its high prevalence and accompanying pathophysiological manifestations. Among patients with severe sepsis, around 10-30% are reported to have diabetes [5][6][7]. Yet the role of diabetes in sepsis is not completely understood.…”

Effect of metabolic control on interferon-gamma and interleukin-10 production by peripheral blood mononuclear cells from type 1 and type 2 diabetic patients

“…The duration and metabolic control of diabetes mellitus seem to be important for the onset and progression of these complications (4)(5)(6). Besides vascular and neurological complications, a high susceptibility to infection has been described in diabetic patients (7)(8)(9)(10)(11)(12)(13)(14), which may be caused by several defects of the immunological defense system. Impairment of polymorphonuclear leukocyte phagocytosis and reduction in granulocyte phagocytic capacity have been reported with the increase of plasma glucose concentration in diabetic patients, and these abnormalities are reversed after insulin therapy (15)(16)(17)(18)(19)(20).…”