Abstract
BackgroundPeople with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control. Our aim was to estimate the association between diabetes and infections occurring in primary care.MethodsUsing the Newfoundland and Labrador Sentinel of the Canadian Primary Care Sentinel Surveillance Network, patients with diabetes ≥18 years between 1 January 2008 and 31 March 2013 were included with at least 1-year of follow-up. We randomly matched each patient with diabetes on the date of study entry with up to 8 controls without diabetes. Primary outcome was the occurrence of ≥1 primary care physician visits for any infectious disease. Secondary outcomes included primary visits for head & neck, respiratory, gastrointestinal, genitourinary, skin and soft tissue, musculoskeletal, and viral infections. Using multivariable conditional logistic regression analysis, we measured the independent association between diabetes and the occurrence of infections.ResultsWe identified 1779 patients with diabetes who were matched to 11,066 patients without diabetes. Patients with diabetes were older, had a higher prevalence of comorbidities, and were more often referred to specialists. After adjusting for potential confounders, patients with diabetes had an increased risk of any infection compared to patients without diabetes (adjusted odds ratio = 1.21, 95% confidence interval 1.07–1.37). Skin and soft tissue infections had the strongest association, followed by genitourinary, gastrointestinal, and respiratory infections. Diabetes was not associated with head and neck, musculoskeletal, or viral infections.ConclusionPatients with diabetes appear to have an increased risk of certain infections compared to patients without diabetes.
Highlights
People with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control
Patients with diabetes were on average older, underwent more laboratory tests in the year prior to study entry, were more likely to receive vaccines, acid-suppressing medications and lipid-lowering medications, and were more likely to have existing macrovascular or microvascular disease at study entry compared to controls
The number of infections and recurrences before 1-year entry to the study was higher in patients with no diabetes, both groups were similar with regards to the average number of doctor visits (Table 1)
Summary
People with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control. As of 2014, there were an estimated 2 million people aged 12 and older living with diabetes in Canada [2]. About 40% of all people with diabetes have at least one physician claim, and nearly 6% have at least one hospitalization for an infectious disease each year [4]. A study conducted in North California estimated the proportion of costs spent on treating complications associated with all types of diabetes across different age groups (< 19 - > 65 years). Costs were categorized by inpatient care, outpatient care (primary care, specialty, emergency, non-physician care), pharmacy and out of plan referrals and claims. They found an excess cost of almost 5 million dollars spent due to infections over
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