Glycemic Control and Risk of Infections Among People With Type 1 or Type 2 Diabetes in a Large Primary Care Cohort Study.

Julia A Critchley, Iain M Carey, Tess Harris, Stephen DeWilde, Fay J Hosking, Derek G Cook

REVIEW


13 November 2018

This paper highlights the problems associated with poor glycemic control and comes up with some interesting findings in relation to poor control and risk of infections. I have given it a lower clinical applicablity rating because we already provide patients with advice on controlling their diabetes so this study is unlikely to change practice.


RELEVANCE 3
INNOVATIVENESS 2
APPLICABILITY 1
OVERALL 2

PAPER DETAILS


TITLE

Glycemic Control and Risk of Infections Among People With Type 1 or Type 2 Diabetes in a Large Primary Care Cohort Study.

ABSTRACT

OBJECTIVE
Diabetes mellitus (DM) increases the risk of infections, but the effect of better control has not been thoroughly investigated.

RESEARCH DESIGN AND METHODS
With the use of English primary care data, average glycated hemoglobin (HbA) during 2008-2009 was estimated for 85,312 patients with DM ages 40-89 years. Infection rates during 2010-2015 compiled from primary care, linked hospital, and mortality records were estimated across 18 infection categories and further summarized as any requiring a prescription or hospitalization or as cause of death. Poisson regression was used to estimate adjusted incidence rate ratios (IRRs) by HbA categories across all DM, and type 1 and type 2 DM separately. IRRs also were compared with 153,341 age-sex-practice-matched controls without DM. Attributable fractions (AF%) among patients with DM were estimated for an optimal control scenario (HbA 6-7% [42-53 mmol/mol]).

RESULTS
Long-term infection risk rose with increasing HbA for most outcomes. Compared with patients without DM, those with DM and optimal control (HbA 6-7% [42-53 mmol/mol], IRR 1.41 [95% CI 1.36-1.47]) and poor control (≥11% [97 mmol/mol], 4.70 [4.24-5.21]) had elevated hospitalization risks for infection. In patients with type 1 DM and poor control, this risk was even greater (IRR 8.47 [5.86-12.24]). Comparisons within patients with DM confirmed the risk of hospitalization with poor control (2.70 [2.43-3.00]) after adjustment for duration and other confounders. AF% of poor control were high for serious infections, particularly bone and joint (46%), endocarditis (26%), tuberculosis (24%), sepsis (21%), infection-related hospitalization (17%), and mortality (16%).

CONCLUSIONS
Poor glycemic control is powerfully associated with serious infections and should be a high priority.



AUTHOR(S)

Julia A Critchley, Iain M Carey, Tess Harris, Stephen DeWilde, Fay J Hosking, Derek G Cook,

JOURNAL

Diabetes care

PLACE

United States