Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Diabetes Program, Endocrinology and Internal Medicine, Kaiser Permanente Northern California, South San Francisco Medical Center, South San Francisco, CA.
Diabetes Care. 2024 Dec 1;47(12):2258-2265. doi: 10.2337/dc24-1612.
To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control.
This retrospective cohort study included adults age ≥65 years with type 2 diabetes from an integrated health care delivery system. Negative binomial models were used to estimate incidence rates and relative risk (RR) of hospitalization for infections (respiratory; genitourinary; skin, soft tissue, and bone; and sepsis), comparing two levels of relaxed (hemoglobin A1c [HbA1c] 7% to <8% and 8% to <9%) with intensive (HbA1c 6% to <7%) glycemic control from 1 January 2019 to 1 March 2020.
Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% with HbA1c 7% to <8%, and 16.1% with HbA1c 8% to <9%), the rate of hospitalization for infections was 51.3 per 1,000 person-years. Compared with HbA1c 6% to <7%, unadjusted risk of hospitalization for infections was significantly elevated among patients with HbA1c 8% to <9% (RR 1.25; 95% CI 1.13, 1.39) but not among patients with HbA1c 7% to <8% (RR 0.99; 95% CI 0.91, 1.08), and the difference became nonsignificant after adjustment. Across categories of infections, the adjusted RR of hospitalization was significantly higher among patients with HbA1c 8% to <9% only for skin, soft tissue, and bone infection (RR 1.33; 95% CI 1.05, 1.69).
Older patients with type 2 diabetes who achieve relaxed glycemic control levels endorsed by clinical guidelines are not at significantly increased risk of hospitalization for most infections, but HbA1c 8% to <9% is associated with an increased risk of hospitalization for skin, soft tissue, and bone infections.
比较强化血糖控制与放松血糖控制患者的感染住院风险。
这项回顾性队列研究纳入了来自综合医疗服务系统的年龄≥65 岁的 2 型糖尿病成人患者。采用负二项式模型来估计 2019 年 1 月 1 日至 2020 年 3 月 1 日期间感染（呼吸道；泌尿生殖系统；皮肤、软组织和骨骼；败血症）住院的发生率和相对风险（RR），比较两种放松血糖控制水平（糖化血红蛋白[HbA1c]7%至<8%和 8%至<9%）与强化血糖控制（HbA1c 6%至<7%）。
在 103242 名老年患者中（48.5%的患者 HbA1c 6%至<7%，35.3%的患者 HbA1c 7%至<8%，16.1%的患者 HbA1c 8%至<9%），感染住院率为 51.3/1000 人年。与 HbA1c 6%至<7%相比，HbA1c 8%至<9%患者的感染住院风险显著升高（RR 1.25；95%CI 1.13，1.39），但 HbA1c 7%至<8%患者的风险无显著升高（RR 0.99；95%CI 0.91，1.08），且校正后差异无统计学意义。在各类感染中，仅皮肤、软组织和骨骼感染的调整 RR 在 HbA1c 8%至<9%患者中显著升高（RR 1.33；95%CI 1.05，1.69）。
符合临床指南推荐的放松血糖控制水平的 2 型糖尿病老年患者，其大多数感染的住院风险并无显著升高，但 HbA1c 8%至<9%与皮肤、软组织和骨骼感染的住院风险增加相关。
