Poorly Regulated Blood Glucose in Diabetic Patients-predictor of Acute Infections

Abstract

Introduction:Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases.Material and methods:The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome.Results:Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus.Conclusion:Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients

“…Nevertheless, it has identified some risk factors like age, gender, or high comorbidity status [9, 13, 15, 16, 18-26, 28, 29]. On the other hand, it is less clear whether clinically modifiable outcomes like, for example, HbA1C [30], or patient characteristics like the body mass index (BMI) [31] may have an own predictive role with regard to the UTI risk in T2DM patients.…”

“…poor glycaemic control and UTI event risk may be related to the positive correlation between the parameters of inflammation and glucoregulation in diabetics, especially with regard to the urinary tract or the soft tissue system [30].…”

Benefits/Risks of Sodium–Glucose Co-Transporter 2 Inhibitor Canagliflozin in Women for the Treatment of Type 2 Diabetes

“…Hyperglycemia contributes to GMIs by providing an environment that facilitates fungal growth, impairs neutrophils and complement proteins, and promotes the virulence of yeasts [5,49]. The risk for developing VVC (or any type of infection) in women with T2DM increases with progressively poorer glycemic control [48,50]. Glucosuria, a symptom of uncontrolled hyperglycemia, predisposes women to VVC, likely because increased glucose in the urine creates conditions conducive to yeast adherence, germination and growth.…”

“…UTIs are the most commonly encountered bacterial infections in the USA; from 40 to 50% of women will experience at least one symptomatic UTIs during their lifetime [2,50,54]. T2DM itself is a risk factor for UTIs; older age, longer duration of disease, poor glycemic control, presence of complications and diabetic kidney disease further increase the risk of UTIs [55–59].…”

Whole Grains in Amelioration of Metabolic Derangements

“…Arnal et al found that a combined treatment with lutein and insulin prevented the development of cataracts in streptozotocin-induced diabetic rats by inhibiting lipid peroxidation in the eye lenses of diabetic rats [31]. Furthermore, Muriach et al discovered that lutein may reduce susceptibility to infections in diabetic patients [32], as diabetic subjects have higher risk of common infections [33, 34]. Another phytonutrient present in whole grains, zeaxanthin, also has the potential to inhibit the development of retinopathy in diabetic patients [35].…”