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Erschienen in: Diabetologia 3/2007

01.03.2007 | Article

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

verfasst von: T. Benfield, J. S. Jensen, B. G. Nordestgaard

Erschienen in: Diabetologia | Ausgabe 3/2007

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Abstract

Aims/hypothesis

Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial.

Materials and methods

We studied 10,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression analysis.

Results

At baseline, 353 individuals reported having diabetes. During 71,509 person-years of follow-up, a total of 1,194 individuals were hospitalised because of an infection. The risk of pneumonia (adjusted hazard ratio [aHR] 1.75, 95% CI 1.23–2.48), urinary tract infection (aHR 3.03, 95% CI 2.04–4.49) and skin infection (aHR 2.43, 95% CI 1.49–3.95) was increased in subjects with diabetes compared with subjects without. Each 1 mmol/l increase in plasma glucose at baseline was associated with a 6–10% increased relative risk of pneumonia, urinary tract infection and skin infection after adjustment for other possible confounders. Among patients hospitalised for urinary tract infection, diabetic patients were at an increased risk of death at 28 days after admission compared with non-diabetic subjects (HR 3.90, 95% CI 1.20–12.66).

Conclusions/interpretation

In the Danish general population, diabetes and hyperglycaemia are strong and independent risk factors for hospitalisation as a result of pneumonia, urinary tract infection and skin infection. Further, diabetes has a negative impact on the prognosis of urinary tract infection.
Literatur
1.
Zurück zum Zitat Shah BR, Hux JE (2003) Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 26:510–513PubMed Shah BR, Hux JE (2003) Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 26:510–513PubMed
2.
Zurück zum Zitat Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT (2005) Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year, population-based study among adults. Clin Infect Dis 40:628–631PubMedCrossRef Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT (2005) Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year, population-based study among adults. Clin Infect Dis 40:628–631PubMedCrossRef
3.
Zurück zum Zitat Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT (2004) Risk of community-acquired pneumococcal bacteremia in patients with diabetes: a population-based case-control study. Diabetes Care 27:1143–1147PubMed Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT (2004) Risk of community-acquired pneumococcal bacteremia in patients with diabetes: a population-based case-control study. Diabetes Care 27:1143–1147PubMed
4.
Zurück zum Zitat Boyko EJ, Fihn SD, Scholes D, Abraham L, Monsey B (2005) Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol 161:557–564PubMed Boyko EJ, Fihn SD, Scholes D, Abraham L, Monsey B (2005) Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol 161:557–564PubMed
5.
Zurück zum Zitat Muller LM, Gorter KJ, Hak E et al (2005) Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 41:281–288PubMedCrossRef Muller LM, Gorter KJ, Hak E et al (2005) Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 41:281–288PubMedCrossRef
6.
Zurück zum Zitat Valdez R, Narayan KM, Geiss LS, Engelgau MM (1999) Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults. Am J Public Health 89:1715–1721PubMedCrossRef Valdez R, Narayan KM, Geiss LS, Engelgau MM (1999) Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults. Am J Public Health 89:1715–1721PubMedCrossRef
7.
Zurück zum Zitat Bertoni AG, Saydah S, Brancati FL (2001) Diabetes and the risk of infection-related mortality in the US. Diabetes Care 24:1044–1049PubMed Bertoni AG, Saydah S, Brancati FL (2001) Diabetes and the risk of infection-related mortality in the US. Diabetes Care 24:1044–1049PubMed
8.
Zurück zum Zitat Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Sorensen HT, Schonheyder HC (2004) Diabetes and outcome of community-acquired pneumococcal bacteremia: a 10-year population-based cohort study. Diabetes Care 27:70–76PubMed Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Sorensen HT, Schonheyder HC (2004) Diabetes and outcome of community-acquired pneumococcal bacteremia: a 10-year population-based cohort study. Diabetes Care 27:70–76PubMed
9.
Zurück zum Zitat Valerius NH, Eff C, Hansen NE et al (1982) Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Med Scand 211:463–467PubMedCrossRef Valerius NH, Eff C, Hansen NE et al (1982) Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Med Scand 211:463–467PubMedCrossRef
10.
Zurück zum Zitat Marhoffer W, Stein M, Maeser E, Federlin K (1992) Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 15:256–260PubMed Marhoffer W, Stein M, Maeser E, Federlin K (1992) Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 15:256–260PubMed
11.
Zurück zum Zitat Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B (1997) Impaired leucocyte functions in diabetic patients. Diabet Med 14:29–34PubMedCrossRef Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B (1997) Impaired leucocyte functions in diabetic patients. Diabet Med 14:29–34PubMedCrossRef
12.
Zurück zum Zitat Ngo BT, Hayes KD, Dimiao DJ, Srinivasan SK, Huerter CJ, Rendell MS (2005) Manifestations of cutaneous diabetic microangiopathy. Am J Clin Dermatol 6:225–237PubMedCrossRef Ngo BT, Hayes KD, Dimiao DJ, Srinivasan SK, Huerter CJ, Rendell MS (2005) Manifestations of cutaneous diabetic microangiopathy. Am J Clin Dermatol 6:225–237PubMedCrossRef
13.
Zurück zum Zitat Hosking DJ, Bennett T, Hampton JR (1978) Diabetic autonomic neuropathy. Diabetes 27:1043–1055PubMed Hosking DJ, Bennett T, Hampton JR (1978) Diabetic autonomic neuropathy. Diabetes 27:1043–1055PubMed
14.
Zurück zum Zitat Appleyard M (1989) The Copenhagen City Heart Study. Osterbroundersogelsen. A book of tables with data from the first examination (1976–78) and a five year follow-up (1981–83). The Copenhagen City Heart Study Group. Scand J Soc Med (Suppl 41):1–160 Appleyard M (1989) The Copenhagen City Heart Study. Osterbroundersogelsen. A book of tables with data from the first examination (1976–78) and a five year follow-up (1981–83). The Copenhagen City Heart Study Group. Scand J Soc Med (Suppl 41):1–160
15.
Zurück zum Zitat Malig C (1996) The civil registration system in Denmark. IIVRS Technical Paper 66. International Institute for Vital Registration and Statistics (IIVRS), Bethesda, MD Malig C (1996) The civil registration system in Denmark. IIVRS Technical Paper 66. International Institute for Vital Registration and Statistics (IIVRS), Bethesda, MD
16.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
17.
Zurück zum Zitat Lange P, Parner J, Vestbo J, Schnohr P, Jensen G (1998) A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 339:1194–1200PubMedCrossRef Lange P, Parner J, Vestbo J, Schnohr P, Jensen G (1998) A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 339:1194–1200PubMedCrossRef
18.
Zurück zum Zitat Dahl M, Tybjaerg-Hansen A, Schnohr P, Nordestgaard BG (2004) A population-based study of morbidity and mortality in mannose-binding lectin deficiency. J Exp Med 199:1391–1399PubMedCrossRef Dahl M, Tybjaerg-Hansen A, Schnohr P, Nordestgaard BG (2004) A population-based study of morbidity and mortality in mannose-binding lectin deficiency. J Exp Med 199:1391–1399PubMedCrossRef
19.
Zurück zum Zitat Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 110:32–35PubMedCrossRef Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 110:32–35PubMedCrossRef
20.
Zurück zum Zitat Benfield TL, Dahl M, Nordestgaard BG, Tybjaerg-Hansen A (2005) Influence of the factor V Leiden mutation on infectious disease susceptibility and outcome: a population-based study. J Infect Dis 192:1851–1857PubMedCrossRef Benfield TL, Dahl M, Nordestgaard BG, Tybjaerg-Hansen A (2005) Influence of the factor V Leiden mutation on infectious disease susceptibility and outcome: a population-based study. J Infect Dis 192:1851–1857PubMedCrossRef
21.
Zurück zum Zitat American Diabetes Association (2005) Diagnosis and classification of diabetes mellitus. Diabetes Care 28(Suppl 1):S37–S42 American Diabetes Association (2005) Diagnosis and classification of diabetes mellitus. Diabetes Care 28(Suppl 1):S37–S42
22.
Zurück zum Zitat Joshi N, Caputo GM, Weitekamp MR, Karchmer AW (1999) Infections in patients with diabetes mellitus. N Engl J Med 341:1906–1912PubMedCrossRef Joshi N, Caputo GM, Weitekamp MR, Karchmer AW (1999) Infections in patients with diabetes mellitus. N Engl J Med 341:1906–1912PubMedCrossRef
23.
Zurück zum Zitat Popov D, Simionescu M (1997) Alterations of lung structure in experimental diabetes, and diabetes associated with hyperlipidaemia in hamsters. Eur Respir J 10:1850–1858PubMedCrossRef Popov D, Simionescu M (1997) Alterations of lung structure in experimental diabetes, and diabetes associated with hyperlipidaemia in hamsters. Eur Respir J 10:1850–1858PubMedCrossRef
24.
Zurück zum Zitat Philips BJ, Redman J, Brennan A et al (2005) Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients. Thorax 60:761–764PubMedCrossRef Philips BJ, Redman J, Brennan A et al (2005) Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients. Thorax 60:761–764PubMedCrossRef
25.
Zurück zum Zitat Geerlings SE, Meiland R, van Lith EC, Brouwer EC, Gaastra W, Hoepelman AI (2002) Adherence of type 1-fimbriated Escherichia coli to uroepithelial cells: more in diabetic women than in control subjects. Diabetes Care 25:1405–1409PubMed Geerlings SE, Meiland R, van Lith EC, Brouwer EC, Gaastra W, Hoepelman AI (2002) Adherence of type 1-fimbriated Escherichia coli to uroepithelial cells: more in diabetic women than in control subjects. Diabetes Care 25:1405–1409PubMed
26.
Zurück zum Zitat Geerlings SE, Brouwer EC, Gaastra W, Verhoef J, Hoepelman AI (1999) Effect of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals. J Med Microbiol 48:535–539PubMedCrossRef Geerlings SE, Brouwer EC, Gaastra W, Verhoef J, Hoepelman AI (1999) Effect of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals. J Med Microbiol 48:535–539PubMedCrossRef
27.
Zurück zum Zitat Bonadio M, Boldrini E, Forotti G et al (2004) Asymptomatic bacteriuria in women with diabetes: influence of metabolic control. Clin Infect Dis 38:e41–e45PubMedCrossRef Bonadio M, Boldrini E, Forotti G et al (2004) Asymptomatic bacteriuria in women with diabetes: influence of metabolic control. Clin Infect Dis 38:e41–e45PubMedCrossRef
28.
Zurück zum Zitat Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef
29.
Zurück zum Zitat Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366PubMedCrossRef Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366PubMedCrossRef
Metadaten
Titel
Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome
verfasst von
T. Benfield
J. S. Jensen
B. G. Nordestgaard
Publikationsdatum
01.03.2007
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 3/2007
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-006-0570-3

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