People living with diabetes face a significantly higher risk of serious infections, hospitalisation and death, with experts warning that infection remains an overlooked health threat in diabetes care.
The warning follows a major study published in Diabetes and presented at the American Diabetes Association Scientific Sessions in New Orleans.
Researchers at City St George’s, University of London, said infections should be treated as a major health hazard across the diabetes spectrum, including among people with Type 1 diabetes, Type 2 diabetes and prediabetes.
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The study, one of the largest of its kind, found that people with diabetes had a higher risk of infections requiring treatment in primary care, hospital admission and, in some cases, death.
Infection was also identified as the third most common underlying cause of death among people with Type 2 diabetes, after cardiovascular disease and cancer.
The researchers are now calling for infection prevention, early recognition and prompt treatment to be given greater prominence in diabetes guidelines in the United Kingdom and globally.
Using anonymised general practice records linked to hospital and mortality data, the researchers examined more than 800,000 people in England over five years.
The study included 33,829 people with Type 1 diabetes, 527,151 with Type 2 diabetes and 273,216 with prediabetes. Their outcomes were compared with those of more than one million people without diabetes who were matched for age, sex and ethnicity.
The risk was highest among people with Type 1 diabetes. Compared with people without diabetes, those with Type 1 diabetes had an 81 per cent higher risk of infections diagnosed and treated in primary care and a 337 per cent higher risk of being hospitalised because of infection.
People with Type 2 diabetes had a 51 per cent higher risk of infection managed in primary care and a 91 per cent higher risk of infection-related hospitalisation.
Even people with prediabetes were at increased risk, with a 35 per cent higher risk of infection managed in primary care and a 33 per cent higher risk of hospitalisation.
Professor Julia Critchley, Professor of Epidemiology at City St George’s, University of London, who led the study, described infections as a major but largely overlooked threat.
“Infections are a major health hazard across the diabetes spectrum and are hiding in plain sight. They are common, serious and often preventable, yet they are mostly absent from clinical guidelines,” she said.
Critchley warned that the growing number of people living with diabetes worldwide makes it increasingly important to address infection risk as part of routine diabetes care.
Lower respiratory tract infections, including pneumonia, were the most common infections requiring hospitalisation among people with Type 1 and Type 2 diabetes.
Among people with Type 2 diabetes, sepsis and lower respiratory tract infections were the leading causes of infection-related death.
The researchers also found a link between blood sugar levels and infection risk.
Among people with Type 1 diabetes, higher blood sugar levels were associated with a greater risk of infection.
For people with Type 2 diabetes, however, fluctuations in blood sugar over time were linked to serious infections requiring hospitalisation.
This suggests that some patients whose average blood sugar levels appear acceptable may still face a higher infection risk if their blood sugar levels fluctuate significantly.
The researchers said infection prevention and early treatment should therefore receive greater attention alongside cardiovascular and metabolic complications in diabetes management.
They called for diabetes guidelines to include clearer advice on infection risk, better blood sugar control, stronger patient education on early symptoms, and changes to primary care triage systems to ensure that people with diabetes receive rapid assessment when infections are suspected.
Critchley said stronger guidance could help healthcare workers recognise infections earlier and intervene before they become life-threatening.
The researchers said recognising infection as a core part of diabetes care could help reduce the growing burden of preventable illness and deaths among people living with diabetes.
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