Infections Requiring Hospitalization, Resulting in Death More Common in Diabetes

An analysis of the ARIC study suggests patients with diabetes had a 67% greater risk of hospitalization for infection than their counterparts without diabetes.

Results of a new study from Johns Hopkins Bloomberg School of Public Health are sounding an alarm related to increased risk of hospitalization and death from infections associated with a diagnosis of diabetes.

Using data from the Atherosclerosis Risk in Communities (ARIC) study, investigators found patients with diabetes had a 67% greater risk of hospitalization for infection compared to their counterparts without diabetes, but this increase in risk became even greater when limiting their analyses to younger and Black participants.

“Diabetes was independently associated with an increased risk of hospitalization for infection. This association was observed across most major types of infection and was more pronounced for younger people and Black people,” wrote investigators. “These associations persisted after adjusting for demographic and cardiometabolic risk factors. The increased risk of hospitalization for infection-associated with diabetes was observed across major types of infections but was especially robust for foot infections.”

With an apparent lack of large studies examining incidence of infection-related hospitalizations and mortality among patients with diabetes compared to otherwise healthy individuals, Michael Fang, PhD, an assistant scientist at Johns Hopkins Bloomberg School of Public Health, and a team of colleagues conducted the current study to fill this knowledge gap. Investigators designed their study as a prospective cohort analysis of the community-based cohort from the ARIC study, which included data from more than 15,000 adults aged 45-64 years from 4 US communities.

After excluding those with missing information from the baseline visit in 1987-1989 and those with missing information related to diabetes status and covariates, investigators identified a cohort of 12,379 participants for analysis. Investigators noted only participants who identified as Black or White were included due to small sample sizes of other participants of another race/ethnicity and, for this same reason, Black participants from Minnesota and Maryland were also excluded.

For the purpose of analysis, presence of diabetes was defined as fasting glucose of 7 mmol/l or more, non-fasting glucose of 11.1 mmol/l or more, a self-reported diagnosis of diabetes by a physician, or use of glucose-lowering medication at study visit 1.

The study cohort of 12,379 participants had a mean age of 54.5 years, 24.7% were Black, and 54.3% were female. The median follow-up time for these participants was 23.8 years and, during that period, 4229 hospitalizations for infection were recorded.

In adjusted analysis, patients with diabetes were at a 67% greater risk of hospitalization for infection than their counterparts without diabetes (HR, 1.67; 95% CI., 1.52-1.83; P <.001). Further analysis indicated this association was consistent across multiple infection types, including UTIs and respiratory infections, but was most pronounced for foot infections (HR, 5.99; 95% CI, 4.38-8.19; P <.001).

Additionally, investigators pointed out the increased risk of hospitalization for infection observed among patients with diabetes was observed across all subgroups and became stronger for Black participants and younger participants (P <.05).

A total of 362 deaths occurred where infection was listed as the underlying cause among the study cohort. In an analysis adjusted for age, sex, and race, the risk of infection mortality was 72% greater among patients with diabetes compared to their counterparts without diabetes (HR, 1.72; 95% CI, 1.28-2.31). Investigators noted this increase in risk was observed across all subgroups.

“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,” investigators wrote.

This study, “Diabetes and the risk of hospitalisation for infection: the Atherosclerosis Risk in Communities (ARIC) study,” was published in Diabetologia.