Infections are major 'health hazard' for people with diabetes

by City St George's, University of London

edited by Gaby Clark, reviewed by Alexander Pol

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Infections should be considered a "health hazard" in people living with diabetes, with experts warning that current clinical guidelines fail to reflect a substantial but underrecognized burden of illness, hospitalization and death. This is according to a major study published today in Diabetes and presented at the American Diabetes Association Scientific Sessions conference in New Orleans.

In one of the largest studies to date, findings reveal that people living with Type 1 diabetes, Type 2 diabetes and prediabetes face higher risks of infection compared with those without diabetes. These risks span infections managed in primary care, those requiring hospital admission and deaths related to infection.

Infection was revealed to be the third most common underlying cause of death in Type 2 diabetes after cardiovascular disease and cancer.

Researchers who led the study at City St George's, University of London, are now calling for infection prevention, early recognition and management to be embedded in diabetes guidelines in the U.K. and globally.

Using anonymized GP records linked to hospital and mortality data, researchers analyzed infection rates in more than 800,000 people across England living with Type 1 diabetes (33,829 people), Type 2 diabetes (527,151) or prediabetes (273,216), and compared them with more than 1 million controls matched for age, sex and ethnicity. They were assessed over five years.

People living with Type 1 diabetes were at the highest risk of infection, with an 81% higher chance of infection diagnosed and managed by their GP and a 337% higher risk of being hospitalized for infection, compared with those without diabetes. People with Type 2 diabetes had a 51% and 91% increased risk of primary care infections and hospitalization, respectively, while those with prediabetes had a 35% and 33% increased risk, respectively.

Professor Julia Critchley, professor of epidemiology from the School of Health & Medical Sciences at City St George's, University of London, who led the study, said, "Infections are a major health hazard across the diabetes spectrum and are hiding in plain sight. They are common, serious and often preventable, yet they are mostly absent from clinical guidelines."

"The number of people living with diabetes across the world is on a dangerously steep rise, and it's a disservice if we do not treat infection risk as a core part of diabetes care. It cannot be an afterthought."

Lower respiratory tract infections, such as pneumonia, were the most common infections requiring hospitalization in patients with Type 1 and Type 2 diabetes. Sepsis and lower respiratory tract infections were the most common causes of infection-related death in people with Type 2 diabetes.

They also found that blood sugar levels and variation in those levels were linked to increased infection risk. In Type 1 diabetes, higher blood sugar levels were linked to increased infection risk. However, in Type 2 diabetes, fluctuations over time, rather than average levels alone, were associated with serious infections requiring hospitalization. This suggests that some patients with seemingly good blood sugar control may still be at elevated risk if their levels vary significantly between clinic visits.

The researchers say infections must be recognized alongside cardiovascular and metabolic complications as a central component of diabetes management. They argue that guidelines should explicitly address infection risk, measures to improve blood sugar control, stronger patient messaging around early presentation of symptoms, and adaptations to primary care triage systems so that people with diabetes are prioritized for rapid assessment and treatment.

Professor Julia Critchley added, "Increased infection risk in diabetes should have greater emphasis in U.K., European and U.S. guidance. By refreshing guidance on a global scale, it will increase awareness among health care workers to aid earlier recognition and prompt intervention, which would help reduce avoidable hospital admissions and deaths."

Journal information: Diabetes

Key medical concepts

Infectious DiseasesDiabetes Type 1Diabetes Type 2PrediabetesLower Respiratory Tract Infection

Clinical categories

EndocrinologyCommon illnesses & PreventionInfectious diseases Provided by City St George's, University of London Who's behind this story?

Gaby Clark

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