J Korean Diabetes.  2017 Mar;18(1):14-19. 10.4093/jkd.2017.18.1.14.

The Effects of Diabetes on Risk of Infection

• Seo JA

• KMID: 2374762
• DOI: http://doi.org/10.4093/jkd.2017.18.1.14

Abstract

A relationship between diabetes and infection has long been accepted clinically. Host-specific factors that are thought to predispose diabetic patients to infection include hyperglycemia-related impairment of the immune response, vascular insufficiency, diabetic peripheral and autonomic neuropathy, and skin and mucosal colonization of pathogens. Some uncommon but life-threatening infections (e.g., malignant otitis media, rhinocerebral mucormycosis, gangrenous cholecystitis) occur almost exclusively in people with diabetes. Previous large population-based observational studies have reported strong associations between higher HbA1c and infection risks for both type 1 and type 2 diabetes. However, the potential of better long-term glycemic control to prevent infection remains controversial due to sparse randomized controlled trials. More high-quality, prospective studies with sufficient control of confounding factors and repeated HbA1c measures are necessary.

Keyword

Diabetes mellitus; Hyperglycemia; Infection

MeSH Terms

Colon
Diabetes Mellitus
Humans
Hyperglycemia
Mucormycosis
Otitis Media
Prospective Studies
Skin

Reference

References

1. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, Rutten GE. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005; 41:281–8.

2. American Diabetes Association. Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care. 1995; 18:1415–27.

3. Czaja CA, Rutledge BN, Cleary PA, Chan K, Stapleton AE, Stamm WE. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Urinary tract infections in women with type 1 diabetes mellitus: survey of female participants in the epidemiology of diabetes interventions and complications study cohort. J Urol. 2009; 181:1129–34. discussion 1134–5.

4. Boreland L, Scott-Hudson M, Hetherington K, Frussinetty A, Slyer JT. The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart Lung. 2015; 44:430–40.

5. Bartelink ML, Hoek L, Freriks JP, Rutten GE. Infections in patients with type 2 diabetes in general practice. Diabetes Res Clin Pract. 1998; 40:15–9.

6. Simonsen JR, Harjutsalo V, Järvinen A, Kirveskari J, Forsblom C, Groop PH, Lehto M. FinnDiane Study Group. Bacterial infections in patients with type 1 diabetes: a 14-year follow-up study. BMJ Open Diabetes Res Care. 2015; 3:e000067.

7. Hirji I, Guo Z, Andersson SW, Hammar N, Gomez-Caminero A. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). J Diabetes Complicat. 2012; 26:513–6.

8. Hammar N, Farahmand B, Gran M, Joelson S, Andersson SW. Incidence of urinary tract infection in patients with type 2 diabetes. Experience from adverse event reporting in clinical trials. Pharmacoepidemiol Drug Saf. 2010; 19:1287–92.

9. Gorter KJ, Hak E, Zuithoff NP, Hoepelman AI, Rutten GE. Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care. Fam Pract. 2010; 27:379–85.

10. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care. 2008; 31:1541–5.

11. Restrepo BI, Twahirwa M, Rahbar MH, Schlesinger LS. Phagocytosis via complement or Fc-gamma receptors is compromised in monocytes from type 2 diabetes patients with chronic hyperglycemia. PLoS One. 2014; 9:e92977.

12. Al-Mashat HA, Kandru S, Liu R, Behl Y, Desta T, Graves DT. Diabetes enhances mRNA levels of proapoptotic genes and caspase activity, which contribute to impaired healing. Diabetes. 2006; 55:487–95.

13. Price CL, Hassi HO, English NR, Blakemore AI, Stagg AJ, Knight SC. Methylglyoxal modulates immune responses: relevance to diabetes. J Cell Mol Med. 2010; 14:1806–15.

14. Ilyas R, Wallis R, Soilleux EJ, Townsend P, Zehnder D, Tan BK, Sim RB, Lehnert H, Randeva HS, Mitchell DA. High glucose disrupts oligosaccharide recognition function via competitive inhibition: a potential mechanism for immune dysregulation in diabetes mellitus. Immunobiology. 2011; 216:126–31.

15. Stegenga ME, van der Crabben SN, Blümer RM, Levi M, Meijers JC, Serlie MJ, Tanck MW, Sauerwein HP, van der Poll T. Hyperglycemia enhances coagulation and reduces neutrophil degranulation, whereas hyperinsulinemia inhibits fibrinolysis during human endotoxemia. Blood. 2008; 112:82–9.

16. Stegenga ME, van der Crabben SN, Dessing MC, Pater JM, van den Pangaart PS, de Vos AF, Tanck MW, Roos D, Sauerwein HP, van der Poll T. Effect of acute hyperglycaemia and/or hyperinsulinaemia on proinflammatory gene expression, cytokine production and neutrophil function in humans. Diabet Med. 2008; 25:157–64.

17. Ferracini M, Martins JO, Campos MR, Anger DB, Jancar S. Impaired phagocytosis by alveolar macrophages from diabetic rats is related to the deficient coupling of LTs to the Fc gamma R signaling cascade. Mol Immunol. 2010; 47:1974–80.

18. Berrou J, Fougeray S, Venot M, Chardiny V, Gautier JF, Dulphy N, Toubert A, Peraldi MN. Natural killer cell function, an important target for infection and tumor protection, is impaired in type 2 diabetes. PLoS One. 2013; 8:e62418.

19. Draghi M, Pashine A, Sanjanwala B, Gendzekhadze K, Cantoni C, Cosman D, Moretta A, Valiante NM, Parham P. NKp46 and NKG2D recognition of infected dendritic cells is necessary for NK cell activation in the human response to influenza infection. J Immunol. 2007; 178:2688–98.

20. Graham PL 3rd, Lin SX, Larson EL. A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med. 2006; 144:318–25.

21. Hostetter MK. Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes. 1990; 39:271–5.

22. Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000; 33:349–65.

23. Ozer A, Altuntas CZ, Izgi K, Bicer F, Hultgren SJ, Liu G, Daneshgari F. Advanced glycation end products facilitate bacterial adherence in urinary tract infection in diabetic mice. Pathog Dis 2015. doi: 10.1093/femspd/ftu004.