Diabetes and the risk of hospitalization with infection

Fang, M.; Ishigami, J.; Echouffo-Tcheugui, J.; Lutsey, P. L.; Pankow, J. S.; Selvin, E.

Introduction: Mechanistic research suggests that diabetes may increase susceptibility to infection. However, few epidemiologic studies have examined this association. Hypothesis: We hypothesize that adults with diabetes will have a higher risk for infection compared to those without diabetes. Methods: We conducted a prospective cohort analysis of diabetes and incident hospitalization with infection using data from the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression models with adjustments for demographics, health behaviors, and cardiometabolic and kidney functioning measures. Diabetes status at baseline (1987-1989) was defined as a fasting glucose ≥126 mg/dL or non-fasting glucose ≥200 mg/dL, or self-report of a diagnosis of diabetes, or current diabetes medication use. First hospitalization with any infection and specific types of infections (respiratory, urinary, foot, sepsis, and postoperative wound) were ascertained from ICD-9 codes in hospital discharge records, with follow-up to September 30, 2015. Results: We included 13,356 participants (mean age, 55;26% black;54% female). During a median follow-up of 18.8 years, there were 7,791 incident hospitalizations with infection. Compared to those without diabetes at baseline, those with diabetes had a greater risk for hospitalization with any infection (adjusted HR: 1.55 [95% CI: 1.45-1.66], Table ). Results were generally consistentacross infection type, and differences were especially pronounced for foot infections (adjusted HR:6.35 [95% CI: 5.27-7.64]). Conclusion: The COVID-19 pandemic has heightened interest in the link between diabetes and susceptibility to infection. Our study suggests diabetes confers significant risk for infection.Enhancing diabetes prevention and management may reduce infection-related morbidity and mortality.