Infection-Related Hospitalizations High for Adults With Diabetes

People with diabetes may face a higher risk for hospitalization for any infection, a new analysis suggested.

In a prospective study of over 12,000 middle-age adults, those with diabetes had a 67% higher risk for infection-related hospitalization compared with adults free of diabetes over the course of nearly 30 years (HR 1.67, 95% CI 1.52-1.83), reported Elizabeth Selvin, PhD, MPH, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues.

Not surprisingly, this was largely driven by infections specifically in feet, with a near sixfold higher risk for foot infections among those with diabetes after adjusting for demographic and cardiometabolic risk factors (HR 5.99, 95% CI 4.38-8.19), the group wrote in Diabetologia.

However, people with diabetes also saw a significantly increased risk for other types of infections requiring hospitalizations compared with people without diabetes:

• Respiratory infections: HR 1.49 (95% CI 1.28-1.74)

• Urinary tract infections: HR 1.58 (95% CI 1.26-1.98)

• Sepsis: HR 1.92 (95% CI 1.62- 2.28)

• Postoperative infections: HR 1.95 (95% CI 1.20-3.15)

Of note, all subgroups of participants with diabetes had this increased risk for infection-related hospitalization. This included all sociodemographic levels, all races, sexes, and ages, and was true regardless of obesity status and health insurance status, the researchers said. However, young people — defined as those under age 55 — and Black patients had even higher risks for infection hospitalization.

The findings strongly suggest “that enhancing prevention and early treatment of infection in those with diabetes is needed to reduce infection-related morbidity and mortality,” Selvin’s group wrote. “This is especially important given the emergence of the COVID-19 pandemic and the rising rates of hospitalization for infection in the USA, both of which have disproportionately affected people with diabetes.”

Seeing how people with diabetes showed a higher risk for hospitalization with nearly every type of infection, the researchers suggested that prevention efforts go beyond just the receipt of vaccinations, such as for the flu and pneumonia, as well as foot ulceration screenings to prevent respiratory and foot infection. Needed instead, Selvin and co-authors said, is “broader guidance on infection prevention and management among those with diabetes,” in order to better prevent all types of infection in patients with diabetes.

The analysis drew on 12,379 participants from the Atherosclerosis Risk in Communities study — average age was approximately 55, a little over half were female, and about a quarter were Black.

The participants were recruited between 1987 and 1989 and subsequently followed for nearly 3 decades until 2019. A total of 10,894 participants were free of diabetes, while 1,485 had the disease, defined as a fasting glucose of 126 mg/dL (≥7 mmol/l) or higher or non-fasting glucose of 200 mg/dL (11.1 mmol/l) or higher, a self-reported diagnosis of diabetes by a healthcare provider, or current use of diabetes medication.

Infection-related hospitalization was noted according to hospital discharge records.

During follow-up, there were 4,229 incident hospitalizations due to injection — a rate of 15.9 per 1000 person-years. Those with diabetes at baseline had an infection rate of 25.4 per 1,000 person-years compared with 15.2 per 1,000 person-years for those without diabetes.

Study limitations, the researchers said, included that because the data on infections were collected from hospital discharge records, milder cases of infection may have been missed, and since HbA1c was not measured at baseline, there could be an underlying association between glycemic control and infection risk.