Diabetes And Its Infections

Serious Infections In Elderly Patients With Diabetes Mellitus

Diabetes mellitus (DM) is a common disease that affects 7%–8% of the overall adult population of the United States [1]. DM occurs in 18% of persons between the ages of 65 and 75 years and in as many as 40% of persons >80 years old; in addition, 23% of persons aged 65–70 years have impaired glucose tolerance, and nearly 50% of cases in elderly individuals with DM remain undiagnosed [2, 3]. Some investigators have linked persistently elevated glucose levels in individuals with DM to the subsequent development of infection and/or to the inability to control established infection [4]. Although optimal glycemic control contributes to the prevention of common and life-threatening infections associated with DM, the enhanced susceptibility to infection has also been attributed to defects in both cell-mediated immunity (CMI) and humoral immunity [5]; furthermore, immune senescence, which occurs as a result of aging and which predominantly affects CMI, results in increased risk for intracellular bacterial, mycobacterial, fungal, and viral infections [6, 7]. Clinical experience has clearly demonstrated that elderly individuals with DM are especially susceptible to infection. Although infections in elderly individuals with DM seem to be no different from those encountered by their younger counterparts, the combination of immune system deficits that can potentially result from DM and aging can presumably lead to serious and life-threatening complications of infection. Moreover, because a significant number of infections in elderly individuals are known to present in a subtle and atypical manner, prompt recognition and treatment with appropriate empirical broad-spectrum antimicrobial agents in conjunction with surgical intervention is often essential to eradicate such infections Continue reading >>

Diabetes And Infections

For people with diabetes, high blood sugars increase the risk of infections starting and spreading more quickly. High blood sugars also slow down the healing process and make infections more resistant to treatment. The first line of defense when it comes to managing the risk for infections is to manage your blood sugar levels as close to your target range as possible because high blood sugar can slow or limit your body’s ability to fight off infection. Some of the more likely places for infections in people with diabetes include the bladder, vagina, feet, kidneys, skin and gums. The Indian Journal of Endocrinology and Metabolism published a study by scientists who explain that the greater frequency of infections in people with diabetes is caused by numerous factors such as: high blood sugar levels that weaken the immune system micro- and macro-angiopathies (blood vessel disease) neuropathy which masks pain signals of an injury decrease in antibacterial activity of urine gastrointestinal and urinary function impairment frequent medical interventions due to other health issues People with diabetes are much more likely than people without diabetes to have a bladder infection which is also known as a urinary tract infection (UTI). UTI infections may involve the ureters, urethra, kidneys or bladder and you may experience pain, tiredness, nausea and fever. If you have a UTI, it is crucial to treat the infection because if not, the bacteria may spread to your kidneys and cause a dangerous kidney infection. An American Diabetes Association (ADA) published article states that more than 50% of men and women with diabetes live with some type of bladder dysfunction which involves symptoms like “urinary urgency, frequency, nocturia, and incontinence.” Early detection and treat Continue reading >>

Sepsis And Diabetes

Diabetes is a chronic (life-long) autoimmune disease that has a significant impact on your life. Having diabetes means you must work to control your blood glucose (sugar) levels to be sure that they don’t get too high or too low. The amount of glucose in your blood is important. Your body needs glucose for energy, but too much of it can destroy body tissues and too little can starve your body of nutrients. People who have diabetes are also at risk of developing wounds and sores that don’t heal well. While the wounds are present, they are at high risk of developing infection. And, again because of the diabetes, the infections can get severe quickly. When infection overwhelms the body, the body can respond by developing sepsis and going into septic shock. Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations. What is diabetes? Your pancreas is a small organ (about 6” by 1.5”) that is part of your digestive system. It is connected to your small intestine and it lies just below your stomach towards the back. Your pancreas has a few roles, one is to help digest the food you eat and another is to secrete (send out) insulin, which stimulates your cells to use the glucose in the food and drink you consume. When a person has diabetes, the pancre Continue reading >>

Your Diabetes Puts You At Greater Risk Of Infections

Diabetes mellitus is a complex, chronic disease. By 2025, the disease will have affected a whopping 380 million people worldwide. Reduced immunity is one of the worst health challenges of diabetes. It makes diabetics vulnerable to a host of infections. Such infections include both common ones as well as those unique to diabetics. An example is rhinocerebral mucormycosis, a type of fungal infection. Diabetics with uncontrolled sugar are at high risk of getting this infection. Those with diabetic ketoacidosis and hyperosmolar hyperglycemic state are particularly vulnerable. Nearly 70% of all reported cases of this fungus in the U.S. happen to diabetics. Diabetes And Infections: What’s The Connection? High blood sugar levels compromise how immune cells work. Our immune system produces special proteins called “antibodies.” These antibodies attach to bacterial cells that cause diseases. And they “mark” these cells for destruction by other cells of the immune system. When blood glucose levels are high, these antibodies get “glycated.” In other words, they are literally “stuck” to glucose molecules, making them ineffective. Hyperglycemia also hampers the production of “cytokines.” Cytokines are the chemical messengers of the immune system. Cytokines play a vital role in communication between cells. This communication is crucial for fighting off infections quickly. High blood sugar also hampers other immune cells called “phagocytes,” which are responsible for destroying bacterial cells. High blood sugar also feeds viruses and bacteria, helping them multiply faster. What Are the Common Infections Related to Diabetes? Urinary Tract Infections (UTIs) Diabetics are at a higher risk of serious infections in their upper urinary tract. These infections affect Continue reading >>

Management Of Infections In Type 2 Diabetes From The Patient's Perspective: A Qualitative Approach - Sciencedirect

Volume 5, Issue 1 , April 2011, Pages 33-37 To explore the knowledge, and health beliefs of patients with type 2 diabetes mellitus (T2DM) regarding management of infections of the urinary tract (UTIs) and lower respiratory tract (LRTIs). Three semi-structured focus groups with 23 patients with T2DM were conducted and analyzed. Only a few patients mentioned specific preventive measures for UTIs and LRTIs, like not smoking and taking enough fluids (n=3). Making a nuisance of oneself, denying the seriousness of the disease and fear of insulin therapy were barriers to health-seeking behaviour. Some people did not complete the course of antibiotics (n=2) or forgot to take the tablets, especially when tablets had to be taken more than once a day (n=4). Our results showed that patients with T2DM lack knowledge and realistic health beliefs about common infections such as UTIs and LRTIs. Health education should aim to help patients with T2DM to interpret symptoms of infections correctly in order to take the appropriate action such as taking preventive measures or taking antibiotics. Identifying patients at high risk of a complicated infection may target education towards those who need it most. Continue reading >>

Infections In Patients With Diabetes Mellitus

This article has no abstract; the first 100 words appear below. Contrary to common belief, the association between diabetes mellitus and increased susceptibility to infection in general is not supported by strong evidence.1,2 However, many specific infections are more common in diabetic patients, and some occur almost exclusively in them. Other infections occur with increased severity and are associated with an increased risk of complications in patients with diabetes. Several aspects of immunity are altered in patients with diabetes. Polymorphonuclear leukocyte function is depressed, particularly when acidosis is also present. Leukocyte adherence, chemotaxis, and phagocytosis may be affected.3–5 Antioxidant systems involved in bactericidal activity may also be impaired.6 The . . . From Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pa. (N.J., G.M.C., M.R.W.); and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston (A.W.K.). Address reprint requests to Dr. Joshi at Pennsylvania State University College of Medicine, Suite UPC 4100, Milton S. Hershey Medical Center, P.O. Box 850, MC-HU15, Hershey, PA 17033. Continue reading >>

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Go to: Diabetes mellitus (DM) is a clinical syndrome associated with deficiency of insulin secretion or action. It is considered one of the largest emerging threats to health in the 21st century. It is estimated that there will be 380 million persons with DM in 2025.[1] Besides the classical complications of the disease, DM has been associated with reduced response of T cells, neutrophil function, and disorders of humoral immunity.[2–4] Consequently, DM increases the susceptibility to infections, both the most common ones as well as those that almost always affect only people with DM (e.g. rhinocerebral mucormycosis).[4] Such infections, in addition to the repercussions associated with its infectivity, may trigger DM complications such as hypoglycemia and ketoacidosis. This article aims to critically review the current knowledge on the mechanisms associated with the greater susceptibility of DM for developing infectious diseases and to describe the main infectious diseases associated with this metabolic disorder. Continue reading >>

What Infections Are You At Risk For With Diabetes?

People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection. What Kinds of Infections Are Most Likely If You Have Diabetes? When you have diabetes, you are especially prone to foot infections, yeast infections, urinary tract infections, and surgical site infections. In addition, yeast cells (Candida albicans) are more likely to colonize the mucous membranes (e.g., mouth, vagina, nose) in people with diabetes. These Candida cells then interfere with the normal infection-fighting action of white blood cells. With white blood cells impaired, Candida can replicate unchecked, causing yeast infections. High blood sugar levels contribute to this process. Other Sources of Diabetes-Related Infection Diabetic neuropathy (nerve damage) causes problems with sensation, particularly in the feet. This lack of sensation sometimes means foot injuries go unnoticed. Untreated injuries can lead to infection. Some types of neuropathy can also lead to dry, cracked skin, which allows a convenient entry point for infection into the body. People with diabetes often have low blood flow to the extremities. With less blood flow, the body is less able to mobilize normal immune defenses and nutrients that promote the body's ability to fight infection and promote healing. Why Are Infections Risky for People With Diabetes? People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defenses in diabetes. Studies have shown that even those who have minimally elevated blood sugar le Continue reading >>

Infection In Patients With Diabetes Mellitus

Practice Essentials Diabetes increases susceptibility to various types of infections. The most common sites of infection in diabetic patients are the skin and urinary tract. Ear, Nose, and Throat Infections Malignant otitis externa and rhinocerebral mucormycosis are 2 head-and-neck infections seen almost exclusively in patients with diabetes. Malignant or necrotizing otitis externa principally occurs in diabetic patients older than 35 years and is almost always due to Pseudomonas aeruginosa. [1] Infection starts in the external auditory canal and spreads to adjacent soft tissue, cartilage, and bone. Patients typically present with severe ear pain and otorrhea. Rhinocerebral mucormycosis collectively refers to infections caused by various ubiquitous molds. [2] Invasive disease occurs in patients with poorly controlled diabetes, especially those with diabetic ketoacidosis. Organisms colonize the nose and paranasal sinuses, spreading to adjacent tissues by invading blood vessels and causing soft tissue necrosis and bony erosion. Urinary Tract Infections Patients with diabetes have an increased risk of asymptomatic bacteriuria and pyuria, cystitis, and, more important, serious upper urinary tract infection. [3, 4] Intrarenal bacterial infection should be considered in the differential diagnosis of any patient with diabetes who presents with flank or abdominal pain. Pyelonephritis makes control of diabetes more difficult by causing insulin resistance; in addition, nausea may limit the patient's ability to maintain normal hydration. Treatment of pyelonephritis does not differ for patients with diabetes, but a lower threshold for hospital admission is appropriate. Skin and Soft Tissue Infections Sensory neuropathy, atherosclerotic vascular disease, and hyperglycemia all predis Continue reading >>

Increased Risk Of Common Infections In Patients With Type 1 And Type 2 Diabetes Mellitus

Background. Clinical data on the association of diabetes mellitus with common infections are virtually lacking, not conclusive, and often biased. We intended to determine the relative risks of common infections in patients with type 1 and type 2 diabetes mellitus (DM1 and DM2, respectively). Methods. In a 12-month prospective cohort study conducted as part of the Second Dutch National Survey of General Practice, we compared 705 adult patients who had DM1 and 6712 adult patients who had DM2 with 18,911 control patients who had hypertension without diabetes. Outcome measures were medically attended episodes of infection of the respiratory tract, urinary tract, and skin and mucous membranes. We applied multivariable and polytomous logistic regression analysis to determine independent risks of infections and their recurrences in patients with diabetes, compared with control patients. Results. Upper respiratory infections were equally common among patients with diabetes and control patients. Patients with diabetes had a greater risk of lower respiratory tract infection (for patients with DM1: adjusted odds ratio [AOR], 1.42 [95% confidence interval {CI}, 0.96–2.08]; for patients with DM2: AOR, 1.32 [95% CI, 1.13–1.53]), urinary tract infection (for patients with DM1: AOR, 1.96 [95% CI, 1.49–2.58]; for patients with DM2: AOR, 1.24 [95% CI, 1.10–1.39]), bacterial skin and mucous membrane infection (for patients with DM1: AOR, 1.59 [95% CI, 1.12–2.24]; for patients with DM2: AOR, 1.33 [95% CI, 1.15–1.54]), and mycotic skin and mucous membrane infection (for patients with DM1: AOR, 1.34 [95% CI, 0.97–1.84]; for patients with DM2: AOR, 1.44 [95% CI, 1.27–1.63]). Risks increased with recurrences of common infections. Conclusions. Patients with DM1 and DM2 are at in Continue reading >>

Diabetes Mellitus And Infection

Some types of infection occur more frequently in patients with diabetes. This increased risk is largely attributable to an altered immune response due to chronic hyperglycaemia, but increased susceptibility to infection may also result from diabetic complications such as diabetic neuropathy and vascular insufficiency. Risk of most common infections is only modestly increased (e.g. 1.2 fold), but a number of rare but potentially fatal infections occur primarily or even almost exclusively in patients with diabetes. These include mucormycosis, emphysematous urinary tract infections, emphysematous cholecystitis, necrotizing fasciitis and malignant otitis externa. Immediate antimicrobial and/or surgical treatment is needed to prevent serious complications from these infections, including death. In general, antimicrobial treatment of infections in patients with diabetes is not different than in patients without diabetes. Glucose lowering therapy often needs to be increased to counter the loss of control associated with infection. Vaccinations against influenza and pneumococcal infections are recommended for patients with diabetes. Incidence and contributing factors People with diabetes are reported to experience 21% more infections than the general population[1]. Several factors may contribute to this, for example possible ‘reporting bias’: more frequent medical visits due to diabetes may lead to better recording of infectious complications. Even so, it seems clear that the risk of many common infections increases in proportion to hyperglycemia. Special problems may also arise in relations to diabetic nephropathy, which may undermine host defences against infection, and peripheral vascular disease which may impair tissue nutrition, oxygen supply and the ability to mount a Continue reading >>

Bacterial Infections In Patients With Type 1 Diabetes: A 14-year Follow-up Study

Abstract Objective This study explored the annual occurrence/incidence of bacterial infections, and their association with chronic hyperglycemia and diabetic nephropathy, in patients with type 1 diabetes. Design In a register-based follow-up study, we investigated the frequency of bacterial infections in patients with type 1 diabetes (n=4748) and age-matched and sex-matched non-diabetic control (NDC) subjects (n=12 954) using nationwide register data on antibiotic drug prescription purchases and hospital discharge diagnoses, collected between 1996 and 2009. Diabetic nephropathy was classified based on the urinary albumin excretion rate (AER). Results The hospitalization rate due to bacterial infections was higher in patients with diabetes compared with NDCs (rate ratio (RR) 2.30 (95% CI 2.11 to 2.51)). The rate correlated with the severity of diabetic nephropathy: RR for microalbuminuria was 1.23 (0.94 to 1.60), 1.97 (1.49 to 2.61) for macroalbuminuria, 11.2 (8.1 to 15.5) for dialysis, and 6.72 (4.92 to 9.18) for kidney transplant as compared to patients with diabetes and normal AER. The annual number of antibiotic purchases was higher in patients with diabetes (1.00 (1.00 to 1.01)) as compared with NDCs (0.47 (0.46 to 0.47)), RR=1.71 (1.65 to 1.77). Annual antibiotic purchases were 1.18-fold more frequent in patients with microalbuminuria, 1.29-fold with macroalbuminuria, 2.43-fold with dialysis, and 2.74-fold with kidney transplant as compared to patients with normal AER. Each unit of increase in glycated hemoglobin was associated with a 6–10% increase in the number of annual antibiotic purchases. Conclusions The incidence of bacterial infections was significantly higher in patients with type 1 diabetes compared with age-matched and sex-matched NDC subjects, and cor Continue reading >>

Diabetes Mellitus And Infectious Diseases: Controlling Chronic Hyperglycemia

As the incidence of diabetes mellitus continues to rise, common focus areas for diabetes control are blood glucose levels, diet, and exercise. Addressing and controlling these factors as well as other factors associated with diabetes are essential for a better quality of life; however, awareness of an increased risk of infections is also warranted in diabetes patients with chronic hyperglycemia. The immune system is comprised of two subcategories: innate immunity and adaptive immunity. Innate immunity, the first line of defense, is activated when a pathogen initially presents itself. This portion of immunity is inherited at birth and is not specific in its mechanism of defense. In addition, it serves the overall immune system by alerting specific cells of pathogen invasion to activate the adaptive immune system. The innate immune system has physical and chemical mechanisms of response. These include but are not limited to sneezing, coughing, sweating, maintenance of normal body temperature, and gram-positive normal flora on the skin. Adaptive immunity is a very specific aspect of a properly functioning immune system that provides protection against previous infections experienced by the host. These responses are mediated by lymphocytes, which consist of natural killer (NK) cells, B cells and T cells. Vaccinations and exposure to pathogens benefit the adaptive immune system by establishing immunologic memory. In the event of another attack by the same foreign organism, the adaptive immune system is able to provide a more efficient response. Complications of Chronic Hyperglycemia Patients with uncontrolled diabetes are considered immunosuppressed due to the negative effects of elevated blood sugars on the immune system. Hyperglycemia impairs overall immunity through diffe Continue reading >>

Diabetes And Infection: How To Spot The Signs

Diabetes can slow down your body's ability to fight infection. The high sugar levels in your blood and tissues allow bacteria to grow and help infections develop more quickly. Common sites for these problems are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment can prevent more serious issues later on. What to Look For Most infections in people with diabetes can be treated. But you have to be able to spot the symptoms. Tell your doctor immediately if you have any of the following: Fever over 101 F Pain, tenderness, redness, or swelling Wound or cut that won't heal Red, warm, or draining sore Sore throat, scratchy throat, or pain when you swallow Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones White patches in your mouth or on your tongue Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy" Painful or frequent peeing or a constant urge to go Bloody, cloudy, or foul-smelling pee *CGM-based treatment requires fingersticks for calibration, if patient is taking acetaminophen, or if symptoms/expectations do not match CGM readings, and if not performed, may result in hypoglycemia. Please see important risk and safety information. Continue reading >>

Diabetes And The Risk Of Infection-related Mortality In The U.s.

Abstract OBJECTIVE—To determine whether diabetes predicts infection-related mortality and to clarify the extent to which this relationship is mediated by comorbid conditions that may themselves increase risk of infection. RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using the Second National Health and Nutrition Examination Survey Mortality Study of 9,208 adults aged 30–74 years in 1976–1980. We defined demographic variables, diabetes, cardiovascular disease (CVD), and smoking by self-report; BMI, blood pressure, and serum cholesterol from baseline examination; and cause-specific mortality from death certificates. RESULTS—Over 12–16 years of follow-up, 36 infection-related deaths occurred among 533 adults with diabetes vs. 265 deaths in 8,675 adults without diabetes (4.7 vs. 1.5 per 1,000 person-years, P < 0.001). Diabetes (RR 2.0, 95% CI 1.2–3.2) and congestive heart failure (2.8, 1.6–5.1) were independent predictors of infection-related mortality after simultaneous adjustment for age, sex, race, poverty status, smoking, BMI, and hypertension. After subdividing infection-related deaths into those with (n = 145) and without (n = 156) concurrent cardiovascular diagnoses at the time of death, diabetic adults were at risk for infection-related death with CVD (3.0, 1.8–5.0) but not without CVD (1.0, 0.5–2.2). CONCLUSIONS—These nationally representative data suggest that diabetic adults are at greater risk for infection-related mortality, and the excess risk may be mediated by CVD. Although diabetes is widely believed to predispose serious infection and the experimental literature supports an association between diabetes and infection, reviews of this topic have concluded that strong epidemiological evidence linking diabetes to Continue reading >>