There is a need to improve infectious risk mitigation in adults with diabetes because they are hospitalized for infections between 2.6 and 15.7 times as often as adults without diabetes, depending on the type of infection, according to a study published in Diabetes Care.

Although the vascular complications of diabetes have substantially declined over the past 20 years, it is unknown how modern medical treatments for infectious diseases have impacted the outcomes of patients with diabetes. This study was designed to investigate this question using data on the estimated rates of hospitalization for infection in adults with diabetes vs those without diabetes from the 2000 to 2015 National Inpatient Sample and the National Health Interview Surveys. Annual hospitalization rates were stratified by type of infection, and Joinpoint regression was used to assess trends.

The rate of hospitalization for infection in 2015 remained >4 times higher in adults with diabetes compared with those without (relative risk [RR], 3.8; 95% CI, 3.8-3.8), and as much as 15.7 times as high, depending on type of infection. The overall rate of hospitalization between 2000 and 2015 increased from 63.1 to 68.7 per 1000 persons in adults with diabetes and from 15.5 to 16.3 in those without. However, between 2008 to 2015, the rates declined by 7.9% in adults without diabetes (from 17.7 to 16.3 per 1000 persons; Δ%/year -1.5; P <.01) while no significant decline was observed in adults with diabetes. This lack of decline was driven by significant increases in the rates of cellulitis and foot infections, as well as a lack of decline in postoperative wound infections and pneumonia in young adults with diabetes. Conversely, risk for mycoses, pneumonia, chronic bronchitis and bronchiolitis were not noted to have changed significantly between 2000 and 2014.

Although this is the largest, nationally representative study on this topic, it had several limitations. The data used represented hospital discharges, not individual patients; the cohort of participants with type 2 diabetes was larger than that of controls; the data were self-reported; the number of influenza cases was potentially underestimated; and the data could not be adjusted for potential confounders.

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The study investigators concluded, “In the U.S., between 2000 and 2015, rates of hospitalizations of common infections requiring hospitalization remained substantially higher in adults with diabetes compared with adults without diabetes. This excess risk has not improved over time, and more alarmingly, rates of hospitalizations with foot infections, cellulitis, and pneumonia have increased in young adults with, but not without, diabetes.” Researchers noted that further research is warranted to understand the driving cause behind these observed increases.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Harding JL, Benoit SR, Gregg EW, Pavkov ME, Perreault L. Trends in rates of infections requiring hospitalization among adults with versus without diabetes in the U.S., 2000-2015 [published online October 15, 2019]. Diabetes Care. doi: 10.2337/dc19-0653