Chaudhry Umar A R, Carey Iain M, Critchley Julia A, DeWilde Stephen, Limb Elizabeth S, Bowen Liza, Panahloo Arshia, Cook Derek G, Whincup Peter H, Harris Tess
Population Health Research Institute, St George's, University of London, London SW17 0RE, United Kingdom.
Population Health Research Institute, St George's, University of London, London SW17 0RE, United Kingdom.
Diabetes Res Clin Pract. 2024 Jan;207:111023. doi: 10.1016/j.diabres.2023.111023. Epub 2023 Nov 19.
People with type 1 diabetes (T1D) have raised infection rates compared to those without, but how these risks vary by age, sex and ethnicity, or by glycated haemoglobin (HbA1c), remain uncertain.
33,829 patients with T1D in Clinical Practice Research Datalink on 01/01/2015 were age-sex-ethnicity matched to two non-diabetes patients. Infections were collated from primary care and linked hospitalisation records during 2015-2019, and incidence rate ratios (IRRs) were estimated versus non-diabetes. For 26,096 people with T1D, with ≥3 HbA1c measurements in 2012-2014, mean and coefficient of variation were estimated, and compared across percentiles.
People with T1D had increased risk for infections presenting in primary care (IRR = 1.81, 95%CI 1.77-1.85) and hospitalisations (IRR = 3.37, 3.21-3.53) compared to non-diabetes, slightly attenuated after further adjustment. Younger ages and non-White ethnicities had greater relative risks, potentially explained by higher HbA1c mean and variability amongst people with T1D within these sub-groups. Both mean HbA1c and greater variability were strongly associated with infection risks, but the greatest associations were at the highest mean levels (hospitalisations IRR = 4.09, 3.64-4.59) for >97 versus ≤53 mmol/mol.
Infections are a significant health burden in T1D. Improved glycaemic control may reduce infection risks, while prompter infection treatments may reduce hospital admissions.
与非1型糖尿病（T1D）患者相比，T1D患者的感染率更高，但这些风险如何随年龄、性别、种族或糖化血红蛋白（HbA1c）水平而变化仍不确定。
2015年1月1日临床实践研究数据链中的33829例T1D患者按年龄、性别、种族与两名非糖尿病患者进行匹配。从初级保健和2015 - 2019年的住院记录中整理感染情况，并估计与非糖尿病患者相比的发病率比（IRR）。对于2012 - 2014年有≥3次HbA1c测量值的26096例T1D患者，估计其平均值和变异系数，并在各百分位数间进行比较。
与非糖尿病患者相比，T1D患者在初级保健中出现感染的风险增加（IRR = 1.81，95%CI 1.77 - 1.85），住院风险增加（IRR = 3.37，3.21 - 3.53），进一步调整后略有减弱。较年轻年龄和非白人种族的相对风险更高，这可能由这些亚组中T1D患者较高的HbA1c平均值和变异性所解释。HbA1c平均值和更大的变异性均与感染风险密切相关，但最大的关联出现在最高平均水平（住院IRR = 4.09，3.64 - 4.59），即>97与≤53 mmol/mol相比。
感染是T1D的一项重大健康负担。改善血糖控制可能降低感染风险，而更及时的感染治疗可能减少住院。
