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Cited by 7Diabetes Treatment and ManagementDiabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patients

Risk of infection in older adults with type 2 diabetes with relaxed glycemic control

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Lipska, Kasia J., Gilliam, Lisa K., Lee, Catherine, Liu, Jennifer Y., Liu, Vincent X., Moffet, Howard H., Parker, Melissa M., Zapata, Heidi +1 more·2024·Diabetes Care
DOI 10.2337/dc24-1612PMC PMC11655405
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Abstract

OBJECTIVE: To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control. RESEARCH DESIGN AND METHODS: This retrospective cohort study included adults age ≥65 years with type 2 diabetes from an integrated health care 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 two levels of relaxed (hemoglobin A1c [HbA1c] 7% to <8% and 8% to <9%) with intensive (HbA1c 6% to <7%) glycemic control from 1 January 2019 to 1 March 2020. RESULTS: Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% with HbA1c 7% to <8%, and 16.1% with HbA1c 8% to <9%), the rate of hospitalization for infections was 51.3 per 1,000 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 nonsignificant 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). 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 an increased risk of hospitalization for skin, soft tissue, and bone infections.

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  • Elevated glucose levels (>180 mg/dL [>10 mmol/L]) increase risks of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises.

    “elevated glucose levels (>180 mg/dL [>10 mmol/L]) increase risks of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [74]

    The Conclusions (page not supplied) state that hyperglycemia increases susceptibility to infection, and report higher hospitalization risk for skin, soft-tissue, and bone infections at HbA1c 8% to <9%. The paper does not establish a glucose threshold of >180 mg/dL or address dehydration, weakness, poor wound healing, or hyperglycemic crises; it also finds no significant increase in hospitalization for most infections at relaxed glycemic-control levels. (LLM, conf=0.88)

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Cited by

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Authors
Lipska, K. J., Gilliam, L. K., Lee, C., Liu, J. Y., Liu, V. X., Moffet, H. H., Parker, M. M., Zapata, H., & Karter, A. J.
Affiliations
  • Yale University (US)
  • Kaiser Permanente South San Francisco Medical Center (US)
  • Kaiser Permanente (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2024-10-22
Volume
47
Issue
12
Pages
2258-2265
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc24-1612
PMC
PMC11655405
OpenAlex
W4403637619
Cited by
7
References
1
Citations by year
2026: 3 · 2025: 4
FWCI
2.31
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • NIA (R01-AG063391, R56AG074986)
  • NIDDK (P30 DK092924)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
type 2 diabetes, older adults, tight glycemic control, HbA1c, infection hospitalization, sepsis, respiratory infections, genitourinary infections, glycemic targets
MeSH terms
Glycemic Control, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Hospitalization, Humans, Infections, Male, Retrospective Studies

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