Risk of Infection in Older Adults with Type 2 Diabetes with Relaxed Glycemic Control

Abstract

<p dir="ltr">OBJECTIVE. To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control.</p><p><br></p><p dir="ltr">RESEARCH DESIGN AND METHODS. Retrospective cohort study of adults ≥65 years old with type 2 diabetes from an integrated healthcare 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 2 levels of relaxed (HbA1c 7% to <8% and 8% to <9%) with intensive (HbA1c 6 to <7%) glycemic control from 1/1/2019 to 3/1/2020. </p><p><br></p><p dir="ltr">RESULTS. Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% 7% to <8%, and 16.1% 8% to <9%), the rate of hospitalization for infections was 51.3 per 1000 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 non-significant 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). </p><p><br></p><p dir="ltr">CONCLUSIONS. 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 increased risk of hospitalization for skin, soft tissue, and bone infections.</p>