A South Korean study out of 4 million adults confirms that type 2 diabetes doubles the risk of serious infections after 5 years of evolution, strengthening the need to optimize infectious prevention in diabetics. The impact of the pre-diabetes remains uncertain.
Diabetes, whether type 1 or 2, exposes more or less severe infectious complications. The vital prognosis can be brought into play and preventive measures are essential to reduce this infectious risk as much as possible.
Building blood sugar is an objective criterion that confirms or asserts the diagnosis of diabetes, as soon as it appears high (≥126 mg/dl) at least two times. However, certain abnormal values, between 100 and 125 mg/dl, which can orient towards a prediabetes. A high fasting blood sugar, but without reaching the defined threshold to make the diabetes diagnosis, is it enough to increase the risk of long-term infection? A large-scale South Korean retrospective cohort study provides answers to this question.
Nearly four million participants
The source of the data is well known Korean National Health Insurance Service – Health Screening Cohort In which were included after four million adults aged 40 to 79 who all benefited from a health assessment between 2002 and 2003, their follow -up being assured and well documented between 2004 and 2015. Four groups were set up according to the basal values ​​of fasting blood sugar or diagnostic elements: (i) normal values ​​(n = 2,675,476); (ii) altered but between 100 and 125 mg/dl (n = 890 402; 23.0 %); (ii) type 2 diabetes for less than 5 years (n = 212 392; 5.5 %); (4) Ancient 2 -type diabetes (≥ 5 years; n = 85 054 ; 2,2 %).
During a ten-year follow-up, all cases of sepsis defined according to hospitalizations or CIM-10 codes were counted. The data has been processed using the proportional risk model of COX, with multiple adjustments taking into account age, sex, comorbidities, body mass index (BMI), smoking, alcohol consumption and physical activity.
An infection risk almost doubled in some cases
The intergroup comparison has revealed that, even in the event of moderate fasting hyperglycemia (group 2), the long -term infectious risk is slightly increased, the adjusted Hazard ratio (HRA) not exceeding 1.03 (95 %CI, 1.01 to 1.05). This risk is much more significant in the event of type 2 diabetes evolving for less than 5 years, the HRA being estimated at 1.43 (95 %CI, 1.40 to 1.47). In the event of illness evolving for more than 5 years, the risk is almost doubled, the HRA then reaching 1.82 (95 %CI, 1.77 to 1.87) (p<0.001). Infectious risk culminates in young diabetic patients (aged under 40), the HRA then being 1.96 (95 %CI, 1.71 to 2.25). A dose-response gradient between blood sugar and risk of sepsis also appears clearly, a fortiori in case of cardiovascular comorbidities.
These results relating to nearly 300,000 patients with type 2 diabetes confirm the reality of infectious risk, while giving a relatively precise idea of ​​its amplitude. Thus, compared to a control population (normal blood sugar), this risk is almost doubled when diabetes has been evolving for more than 5 years or when the patient is young (<40 years). Under these conditions, everything must be done to better prevent potentially serious infections, using vaccination in the face of some of them and by strengthening education or information measures, aimed at optimizing the management of the infectious complications of the disease. Anticipation is part of the specifications, because early antibiotic therapy can avoid a drama, in the same way as meticulous care of a threatening diabetic foot ...
Moderate fasting hyperglycemia would slightly increase this risk. However, the amplitude of the effect is modest and it is difficult to conclude, especially since the study is retrospective and that it is not without limits: definition of infections from an administrative coding and not of a clinical observation, absence of data concern HBA1C or even long -term glycemic control, no distinction between community infections and nosocomials.