Individuals with diabetes are significantly more likely to be hospitalised and have a higher risk of dying from infections, according to a new study published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]), and this elevated risk is more pronounced in younger adults with diabetes and black people.
Diabetes is thought to increase infection risk by decreasing the body’s immune response. People with diabetes have a higher risk of both common and rare infections, which supports this hypothesis, and the disease has recently emerged as a significant risk factor for COVID-19-related adverse outcomes.
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The authors highlighted: “From 2000 to 2015 the overall rate of hospitalisation from infections in US adults rose significantly, especially in people with diabetes.”
Previous research has shown a link between diabetes and infection risk, but these studies have mostly used small clinical populations and had short follow-up periods.
The researchers used data from the Atherosclerosis Risk in Communities (ARIC) study, which enrolled 15,792 adults aged 45 to 64 in four communities across the United States between 1987 and 1989. Participants underwent initial clinical examinations, medical interviews, and lab tests, with seven follow-up visits from 1990-1992 to 2018-2019. After excluding participants for reasons like lack of information, the researchers had 12,379 people in their sample with a mean age of 54.5 years, 54.3 percent female and 24.7 percent black.
Participants in the ARIC study were given detailed demographic and lifestyle information, including their age, gender, race, study center location, health insurance status, household income, and education level, as well as health behaviors such as smoking and alcohol consumption.
There were 4,229 relevant cases of hospitalization during the average follow-up period of 23.8 years, resulting in an overall rate of 15.9 cases per 1,000 person-years. Individuals with diabetes had a significantly higher risk of being admitted to the hospital than those without the disease (25.4 vs 15.2 per 1,000 person-years).
After adjusting for sociodemographic factors, participants with diabetes had a 92 percent higher rate of infection hospitalization and a 72 percent higher mortality rate than non-diabetics.
This link between diabetes and hospitalisation risk was found in all subgroups, but it was especially strong in black participants and those under 55 years old – diabetes was linked to a roughly doubling of the risk of infection hospitalisation and a more than 50% increased mortality risk in both of these groups.
The link was found to exist for nearly every type of infection, with hospitalisation due to a foot infection 6 times more likely in diabetics.
The authors say:
“Diabetes was independently associated with an increased risk of hospitalisation for infection. This association was observed across most major types of infection and was more pronounced for younger people and Black people. These associations persisted after adjusting for demographic and cardiometabolic risk factors. The increased risk of hospitalisation for infection-associated with diabetes was observed across major types of infections but was especially robust for foot infections.”
The team also note:
“The risk of infection mortality was increased also for those with diabetes compared with those without diabetes. More comprehensive clinical guidance to improve infection-related preventive measures and early treatment of infection may reduce related morbidity and mortality in people with diabetes.”
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The authors conclude that infection prevention and management have become even more critical in light of the COVID-19 pandemic and the general trend toward higher rates of infection-related hospitalizations: two factors that have disproportionately impacted people with diabetes.