Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
Diabetes Care. 2021 Feb;44(2):367-372. doi: 10.2337/dc19-1393. Epub 2020 Dec 1.
We know that diabetes predisposes to common infections, such as cellulitis and pneumonia. However, the correlation between the level of glycemic control and the rate of infection is unknown.
We examined the association between glycemic control in patients with diabetes and the incidence of infection in the entire population of patients with diabetes in a large HMO. During the study period, we first selected an HbA test for each patient and then searched for an infection diagnosis in the 60 days that followed the test. A multivariate logistic regression analysis was performed to determine the independent effect of HbA on the likelihood of being diagnosed with an infection. We were able to control for many confounders, such as other chronic illness, time since the diagnosis of diabetes, and use of steroids before the infection.
We identified 407 cases of cellulitis. Multivariate logistic regressions for cellulitis showed a 1.4-fold increased risk among patients with HbA >7.5% (58 mmol/mol). Factors such as obesity, Parkinson's disease, peripheral vascular disease, and prior treatment with prednisone predisposed to cellulitis. There was an increase of 12% in the odds of cellulitis for every 1% (11 mmol/mol) elevation in HbA (odds ratio [OR] 1.12; CI 1.05-1.19). A similar analysis showed a trend toward an increased risk of pneumonia in patients with HbA >7.5% (58 mmol/mol) (OR 1.1; CI 0.9-1.4).
Poor glycemic control was associated in this study with the development of cellulitis. The study also suggests that exposure to oral prednisolone increases the risk of cellulitis, pneumonia, and upper respiratory infection.
我们知道糖尿病易患常见感染，如蜂窝织炎和肺炎。然而，血糖控制水平与感染率之间的相关性尚不清楚。
我们研究了大型 HMO 中糖尿病患者的血糖控制水平与感染发生率之间的关系。在研究期间，我们首先为每位患者选择了一次 HbA 检测，然后在检测后的 60 天内搜索感染诊断。进行多变量逻辑回归分析，以确定 HbA 对感染诊断可能性的独立影响。我们能够控制许多混杂因素，如其他慢性疾病、糖尿病诊断后的时间以及感染前使用类固醇。
我们确定了 407 例蜂窝织炎病例。蜂窝织炎的多变量逻辑回归显示，HbA >7.5%（58mmol/mol）的患者感染风险增加 1.4 倍。肥胖、帕金森病、外周血管疾病和感染前使用泼尼松龙等因素易患蜂窝织炎。HbA 每升高 1%（11mmol/mol），蜂窝织炎的几率增加 12%（比值比 [OR] 1.12；95%CI 1.05-1.19）。类似的分析显示，HbA >7.5%（58mmol/mol）的患者肺炎风险呈增加趋势（OR 1.1；95%CI 0.9-1.4）。
在这项研究中，较差的血糖控制与蜂窝织炎的发展相关。该研究还表明，口服泼尼松龙暴露增加了蜂窝织炎、肺炎和上呼吸道感染的风险。
