Population Health Research Institute, St George's, University of London, London, U.K.
Diabetes Care. 2018 Mar;41(3):513-521. doi: 10.2337/dc17-2131. Epub 2018 Jan 12.
We describe in detail the burden of infections in adults with diabetes within a large national population cohort. We also compare infection rates between patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM).
A retrospective cohort study compared 102,493 English primary care patients aged 40-89 years with a diabetes diagnosis by 2008 ( = 5,863 T1DM and = 96,630 T2DM) with 203,518 age-sex-practice-matched control subjects without diabetes. Infection rates during 2008-2015, compiled from primary care and linked hospital and mortality records, were compared across 19 individual infection categories. These were further summarized as any requiring a prescription or hospitalization or as cause of death. Poisson regression was used to estimate incidence rate ratios (IRRs) between ) people with diabetes and control subjects and ) T1DM and T2DM adjusted for age, sex, smoking, BMI, and deprivation.
Compared with control subjects without diabetes, patients with diabetes had higher rates for all infections, with the highest IRRs seen for bone and joint infections, sepsis, and cellulitis. IRRs for infection-related hospitalizations were 3.71 (95% CI 3.27-4.21) for T1DM and 1.88 (95% CI 1.83-1.92) for T2DM. A direct comparison of types confirmed higher adjusted risks for T1DM versus T2DM (death from infection IRR 2.19 [95% CI 1.75-2.74]). We estimate that 6% of infection-related hospitalizations and 12% of infection-related deaths were attributable to diabetes.
People with diabetes, particularly T1DM, are at increased risk of serious infection, representing an important population burden. Strategies that reduce the risk of developing severe infections and poor treatment outcomes are under-researched and should be explored.
我们详细描述了在一个大型全国人群队列中成年糖尿病患者的感染负担。我们还比较了 1 型和 2 型糖尿病（T1DM 和 T2DM）患者的感染率。
一项回顾性队列研究比较了 2008 年诊断为糖尿病的 102493 名 40-89 岁的英国初级保健患者（=5863 例 T1DM 和 =96630 例 T2DM）与 203518 名年龄、性别、实践匹配的无糖尿病对照患者。2008-2015 年期间从初级保健和关联的医院和死亡率记录中汇编的感染率，根据 19 种单独的感染类别进行了比较。这些进一步总结为需要处方或住院治疗或作为死亡原因的感染。使用泊松回归估计糖尿病患者和对照患者之间（人群水平）和 T1DM 和 T2DM 患者之间（个体水平）的发病率比（IRR），并调整年龄、性别、吸烟、BMI 和贫困状况。
与无糖尿病的对照患者相比，糖尿病患者的所有感染率均较高，骨和关节感染、败血症和蜂窝织炎的 IRR 最高。T1DM 的感染相关住院的 IRR 为 3.71（95%CI 3.27-4.21），T2DM 的感染相关住院的 IRR 为 1.88（95%CI 1.83-1.92）。对类型的直接比较证实了 T1DM 相对于 T2DM 的调整后风险更高（感染相关死亡的 IRR 为 2.19[95%CI 1.75-2.74]）。我们估计，6%的感染相关住院和 12%的感染相关死亡归因于糖尿病。
糖尿病患者，特别是 T1DM 患者，患严重感染的风险增加，这是一个重要的人群负担。减少发生严重感染和不良治疗结局风险的策略研究不足，应加以探索。
