Severe Infections Rising Among Americans With Diabetes
The number of Americans with diabetes who wind up in hospitals with serious infections, or who develop them while in the hospital, is on the rise.
Between 2010 and 2015, the number of diabetics hospitalized for infections rose 52 percent (from 16 per 1,000 people to 24 per 1,000), according to researchers from the U.S. Centers for Disease Control and Prevention.
"People with diabetes are more susceptible to in-hospital infections as compared with people without diabetes, and this risk is increasing," said lead researcher Jessica Harding, from the CDC's Division of Diabetes Translation.
"The most common infection types in people with and without diabetes were respiratory tract and skin infections," Harding said. But the rates of infection were seven times higher in people with diabetes, she added.
The rise in overall infections is largely driven by increases in patients who develop sepsis while in the hospital, Harding said. "However, we also see in people with diabetes an increase in foot ulcers, coinciding with an increase in lower limb amputations," she added.
Dr. Louis Philipson, director of the University of Chicago Kovler Diabetes Center, said it isn't clear why diabetics develop more infections.
"We do not even have data as to whether the infections occurred in people with more poorly controlled diabetes, though that seems like a reasonable guess," said Philipson, who is also president-elect for medicine and science at the American Diabetes Association.
High blood sugar decreases the activity of the immune system and can cause many changes in tissue, skin and blood flow, all of which can increase the risk of infections, Philipson said.
"Exactly which factors are most important here, and whether access to health care played a role, we do not know yet," he added.
Urinary tract, skin and connective tissue infections are associated with high blood sugar levels and poorly controlled diabetes, Philipson explained. Preventing diabetes and reaching the optimum targets for blood sugar control are key to reducing infections.
"Along with that, regular visits to a primary care doctor and specialist as needed to get the best foot care, eye care and review of kidney function will go a long way towards preventing complications of diabetes," Philipson said.
For the study, Harding and her colleagues used national hospitalization data from 2000 to 2015. The data captured about 20 percent of all hospitalizations in 46 states, representing more than 96 percent of the U.S. population.
The investigators found that people with diabetes are about two to seven times more likely to be hospitalized with an infection than the general population.
"Improved access to preventive care, as well as promoting education to reduce risk factors for underlying disease processes, will be essential to decrease the risk of infections in people with diabetes," Harding said.
Dr. Joel Zonszein directs the Clinical Diabetes Center at Montefiore Medical Center in New York City. He said it's concerning that the majority of patients with diabetes are not treated properly, since high blood sugar levels predispose them to infections.
"We have proper ways to treat diabetes, and there should be no excuse why patients shouldn't be getting the best care," he said. "More research is not needed -- more effective treatment is imperative."
The results of the study were scheduled for presentation Tuesday at the meeting of the European Association for the Study of Diabetes, in Berlin. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Visit the American Diabetes Association for more on type 2 diabetes.
SOURCES: Jessica Harding, Ph.D., Division of Diabetes Translation, U.S. Centers for Disease Control and Prevention; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Louis Philipson, M.D., Ph.D., director, University of Chicago Kovler Diabetes Center, and president-elect, medicine and science, American Diabetes Association; Oct. 2, 2018, presentation, European Association for the Study of Diabetes meeting, Berlin