Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study

Diabet Med. 2017 Apr;34(4):551-557. doi: 10.1111/dme.13205. Epub 2016 Sep 22.

Abstract

Aim: To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes.

Methods: We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c < 53 mmol/mol (< 7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c > 69 mmol/mol (> 8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities.

Results: We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex.

Conclusions: Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control.

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Bronchitis / epidemiology
  • Case-Control Studies
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / metabolism
  • Female
  • Glycated Hemoglobin A / metabolism
  • Herpes Simplex / epidemiology
  • Humans
  • Infections / epidemiology*
  • Influenza, Human / epidemiology
  • Intestinal Diseases / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Multilevel Analysis
  • Pneumonia / epidemiology
  • Respiratory Tract Infections / epidemiology
  • Skin Diseases, Infectious / epidemiology
  • Soft Tissue Infections / epidemiology
  • United Kingdom / epidemiology
  • Urinary Tract Infections / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human