Experts have warned that current clinical guidelines do not reflect the under-recognized burden of disease, hospitalization and death. This is according to a major study published today. diabetes and was published in American Diabetes Association Academic Sessions Conference in New Orleans.
One of the largest studies to date found that people with type 1 diabetes, type 2 diabetes, and prediabetes are at higher risk of infection than people without diabetes. These risks range from infections managed in primary care, infections requiring hospitalization, and infection-related deaths.
Infectious diseases have been found 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 detection and management to be integrated into UK and global diabetes guidelines.
Researchers analyzed infection rates in more than 800,000 people across the UK with type 1 diabetes (33,829 people), type 2 diabetes (527,151 people) or prediabetes (273,216 people) using anonymized GP records linked to hospital and mortality data, and compared them with more than 1 million age-, sex- and ethnicity-matched controls. They were evaluated over a 5-year period.
People living with type 1 diabetes were at the highest risk of infection, with an 81% higher chance of an infection being diagnosed and managed by their GP and a 337% higher risk of being hospitalized due to an infection compared to people without diabetes. Patients with type 2 diabetes had a 51% and 91% increased risk of primary care infection and hospitalization, respectively, while prediabetics had a 35% and 33% increased risk, respectively.
Professor Julia Critchley, professor of epidemiology at City St George’s School of Health and Medical Sciences, University of London, who led the study, said:
“Infectious diseases are a major health hazard across the diabetes spectrum, hiding in plain sight. Infectious diseases are common, serious, and often preventable, yet they are rarely mentioned in clinical guidelines.
“The number of people living with diabetes around the world is increasing dangerously and it would be a shame not to treat infection risk as a core part of diabetes care. We cannot afford to put it on the back burner.”
Lower respiratory tract infections, such as pneumonia, were the most common infections requiring hospitalization in type 1 and type 2 patients. Sepsis and lower respiratory tract infections were the most common causes of infection-related deaths in patients with type 2 diabetes.
They also found that blood sugar levels and fluctuations were associated with increased risk of infection. In type 1 diabetes, elevated blood sugar levels were associated with increased risk of infection. However, in type 2 diabetes, not only mean levels but also variations over time were associated with severe infections requiring hospitalization. This suggests that some patients who appear to have good glycemic control may still be at high risk if their blood sugar levels vary widely from visit to visit.
Researchers say infections should be recognized as a central component of diabetes management, along with cardiovascular and metabolic complications. They argue that guidelines should explicitly address infection risk, strategies to improve glycemic control, support stronger messaging to patients about the early onset of symptoms, and encourage adaptations to primary care triage systems to prioritize rapid assessment and treatment for people with diabetes.
Guidance from the UK, Europe and the US needs to focus more on the increased risk of infection in diabetes. Updated global guidance will increase awareness among healthcare professionals, promote early detection and prompt intervention, and lead to fewer avoidable hospitalizations and deaths. ”
Professor Julia Critchley, Professor of Epidemiology, City St George’s School of Health and Medical Care, University of London
This research was funded by the National Institute for Health and Care Excellence (NIHR).
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City St. George’s, University of London
