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Infections Associated With Diabetes
Diabetes in America. National Institute of Diabetes and Digestive and Kidney Diseases (US): Bethesda (MD).BOOK

Abstract
Evidence supporting the notion that diabetes predisposes to an increased risk of infection continues to be inconclusive. In fact, in patients with diabetes, the percentage of outpatient visits to a physician because of an infection ranges from 1.6% to 5.1%, whereas individuals without diabetes average 2.6%–3.6% outpatient visits to physicians as a result of an infection. Additionally, compared to the general population, the percentage of deaths due to infection in those diagnosed with diabetes ranges from 2.7% to 3.4% compared to a range of 4.1% to 4.6% in individuals without diabetes. In individuals with diabetes, the mechanisms have not been clearly elucidated but are partly attributed to the effect of hyperglycemia on the immune system, increased risk of local tissue ischemia, and neuropathy. The available evidence suggests that individuals with diabetes are more likely to develop certain infections, including asymptomatic bacteriuria (especially women), urinary tract infection, pyelonephritis, renal and perinephric abscess, lower extremity infections, deep subcutaneous tissue infections, postoperative sternal wound infections, and tuberculosis compared to individuals without diabetes. In 2010, 2.8% of hospital discharges for persons diagnosed with diabetes were due to foot ulcers, a stark contrast when compared to only 0.6% of discharges due to foot ulcers in individuals without diabetes. There is inadequate evidence linking diabetes to an increased risk of pneumonia or influenza. The case fatality rate among individuals with diabetes who are diagnosed with a respiratory tract infection, such as influenza, sinusitis, and bronchitis, ranges from 1% to 1.4% compared to a range of 1.9% to 2.4% in individuals without diabetes. Most clinical guidelines recommend persons with diabetes receive the pneumonia and influenza vaccines. Similar to the evidence linking diabetes to respiratory tract infections, the evidence linking diabetes to an increased risk of fungal infections, superficial bacterial skin and soft tissue infections, sinusitis, or bronchitis, is weak. However, there are infections that occur almost exclusively among individuals with diabetes, including: emphysematous pyelonephritis and emphysematous cholecystitis, malignant otitis externa, and rhinocerebral mucormycosis. Additionally, diabetes has been identified as a risk factor for invasive group B streptococcal infections in nonpregnant adults. Immunological defects, microangiopathy, and autonomic and sensory neuropathy have all been implicated as risk factors for the aforementioned infections in individuals with diabetes. This chapter summarizes the body of evidence on the relationship between diabetes and infectious disease risks and outcomes.

Authors

Senior Advisor and Director for Diabetes Epidemiology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MDSenior Research Analyst, Social & Scientific Systems, Inc., Silver Spring, MDSenior Research Analyst, Social & Scientific Systems, Inc., Silver Spring, MDScience Writer/Editor, Chicago, ILEpidemiologist, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MDProfessor of Medicine, Harvard Medical School, and Physician, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MAChief, Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GAChief, Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZDistinguished Professor, Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CAProfessor of Pediatrics, Division of Endocrinology and Diabetes, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PADistinguished Service Professor of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MDProfessor, University of Washington, and Staff Physician, Veterans Affairs Puget Sound, Seattle, WAProfessor, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MIProfessor of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, Georgetown University Hospital, and Senior Scientist, MedStar Health Research Institute, Hyattsville, MDDirector, Emory Global Diabetes Research Center, Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, and Professor of Medicine, School of Medicine, Emory University, Atlanta, GAProfessor of Pediatrics and Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CODirector, Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Publisher

National Institute of Diabetes and Digestive and Kidney Diseases (US)
Bethesda (MD)

Language

eng

PubMed ID

33651550

Citation

Egede LE, Hull BJ, Williams JS: Infections Associated With Diabetes. Diabetes in America. Edited by Cowie CC, et al: National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018, Bethesda (MD).
Egede LE, Hull BJ, Williams JS. Infections Associated With Diabetes. Edited by Cowie CC, Casagrande SS, Menke A, et al. Diabetes in America. National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018.
Egede LE & Hull BJ & Williams JS. (2018). Infections Associated With Diabetes. Edited by Cowie CC & Casagrande SS & Menke A, et al. In Diabetes in America. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US)
Egede LE, Hull BJ, Williams JS. Infections Associated With Diabetes. Edited by Cowie CC, et al. Diabetes in America. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018.
* Article titles in AMA citation format should be in sentence-case
TY - CHAP T1 - Infections Associated With Diabetes BT - Diabetes in America A1 - Egede,Leonard E., AU - Hull,Beatrice J., AU - Williams,Joni S., Y1 - 2018/08// PY - 2021/3/3/pubmed PY - 2021/3/3/medline PY - 2021/3/3/entrez N2 - Evidence supporting the notion that diabetes predisposes to an increased risk of infection continues to be inconclusive. In fact, in patients with diabetes, the percentage of outpatient visits to a physician because of an infection ranges from 1.6% to 5.1%, whereas individuals without diabetes average 2.6%–3.6% outpatient visits to physicians as a result of an infection. Additionally, compared to the general population, the percentage of deaths due to infection in those diagnosed with diabetes ranges from 2.7% to 3.4% compared to a range of 4.1% to 4.6% in individuals without diabetes. In individuals with diabetes, the mechanisms have not been clearly elucidated but are partly attributed to the effect of hyperglycemia on the immune system, increased risk of local tissue ischemia, and neuropathy. The available evidence suggests that individuals with diabetes are more likely to develop certain infections, including asymptomatic bacteriuria (especially women), urinary tract infection, pyelonephritis, renal and perinephric abscess, lower extremity infections, deep subcutaneous tissue infections, postoperative sternal wound infections, and tuberculosis compared to individuals without diabetes. In 2010, 2.8% of hospital discharges for persons diagnosed with diabetes were due to foot ulcers, a stark contrast when compared to only 0.6% of discharges due to foot ulcers in individuals without diabetes. There is inadequate evidence linking diabetes to an increased risk of pneumonia or influenza. The case fatality rate among individuals with diabetes who are diagnosed with a respiratory tract infection, such as influenza, sinusitis, and bronchitis, ranges from 1% to 1.4% compared to a range of 1.9% to 2.4% in individuals without diabetes. Most clinical guidelines recommend persons with diabetes receive the pneumonia and influenza vaccines. Similar to the evidence linking diabetes to respiratory tract infections, the evidence linking diabetes to an increased risk of fungal infections, superficial bacterial skin and soft tissue infections, sinusitis, or bronchitis, is weak. However, there are infections that occur almost exclusively among individuals with diabetes, including: emphysematous pyelonephritis and emphysematous cholecystitis, malignant otitis externa, and rhinocerebral mucormycosis. Additionally, diabetes has been identified as a risk factor for invasive group B streptococcal infections in nonpregnant adults. Immunological defects, microangiopathy, and autonomic and sensory neuropathy have all been implicated as risk factors for the aforementioned infections in individuals with diabetes. This chapter summarizes the body of evidence on the relationship between diabetes and infectious disease risks and outcomes. PB - National Institute of Diabetes and Digestive and Kidney Diseases (US) CY - Bethesda (MD) UR - https://www.unboundmedicine.com/medline/citation/33651550/Diabetes_in_America:_Infections_Associated_With_Diabetes L2 - https://www.ncbi.nlm.nih.gov/books/NBK567992 DB - PRIME DP - Unbound Medicine ER -
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