By Colin Kenny, Editor – Diabetes Distilled
As diabetes is associated with a higher risk of infection, researchers wanted to determine whether degree of diabetes control impacts on this risk. They examined cohorts without diabetes, those with optimal control and those with poor control. For most patients, long-term infection risk rose with increasing HbA1c level. Poor control was associated with higher risk of hospitalisation for infection, particularly in those with type 1 diabetes. They concluded that poor glycaemic control is associated with serious infections and improving HbA1c should be a high priority.
Investigators used an English primary care database to estimate the average HbA1c levels of 85,312 patients with diabetes aged 40–89 years. Infection rates across 18 categories were then compiled for this cohort from primary care records and linked to hospital admissions and mortality records. These data were further summarised as infections requiring a prescription or hospitalisation or as a cause of death. Incident rates were compared with 153,341 age–sex–practice-matched controls without diabetes.
Long-term infection risk was found to rise with increasing HbA1c for most outcomes. Patients with diabetes, whether they had optimal (HbA1c 42–53 mmol/mol; 6–7%) or poor control (≥97 mmol/mol; ≥11%), had a higher risk of hospitalisation from infection than matched controls without diabetes. This risk was even higher in patients with type 1 diabetes and poor control. After adjusting for duration of diabetes and other confounders, poor glycaemic control was confirmed to elevate the risk of hospitalisation. Poor control led to high risks for serious infection, particularly bone and joint (46%), endocarditis (26%), tuberculosis (24%), sepsis (21%), infection-related hospitalisation (17%) and mortality (16%).
There is a strong association between poor glycaemic control and serious infection. Management of this risk factor should be a high priority in people with diabetes.
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