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 >>
Standards Of Medical Care For Patients With Diabetes Mellitus
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested persons with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Skyler (Ed.): Medical Management of Type 1 Diabetes (1) and Zimmerman (Ed.): Medical Management of Type 2 Diabetes (2). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. CLASSIFICATION, DIAGNOSIS, AND SCREENING Classification In 1997, the ADA issued new diagnostic and classification criteria (3). The classification of diabetes mellitus includes four clinical classes: Type 1 diabetes (results from β Continue reading >>
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What Causes Vaginal Infections (with Diabetes) And What Are The Best Treatments?
Yahoo!-ABC News Network | 2018 ABC News Internet Ventures. All rights reserved. What Causes Vaginal Infections (With Diabetes) And What Are The Best Treatments? SARVER HEART CENTER AT THE UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE Question: What causes vaginal infections (with diabetes) and what are the best treatments? Answer: Women with diabetes are at higher risk for developing vaginal infections than women without diabetes, and, in addition, if the woman's diabetes is not well controlled and her blood sugars are consistently high, that creates an environment of high sugar in the mucus membranes, and of course, that includes the vagina, and this creates a good environment for the overgrowth of both bacteria and yeast. So, those are the two main areas of infection, the two main causes of infection -- vaginal infection in women -- are bacteria and yeast. If it's a bacterial infection, the woman would need an antibiotic for treatment, and a yeast infection can be treated with anti-fungal agents. So it's important for a woman to see her primary care provider or gynecologist to have this condition diagnosed as probably one or the other. The caveat is, if a woman has had a yeast infection recently and the identical symptoms come back, and she's very confident that it's another yeast infection, she might be able to use an over-the-counter cream or suppository to treat that infection. And, in addition, if the yeast infection is recurrent, she could ask her health care provider for a prescription for an oral anti-fungal agent like fluconazole. But the most important thing is that a woman with diabetes is at higher risk for these vaginal infections when the blood sugar level is out of control, so it becomes critically important, then, to treat these infections with better bloo Continue reading >>
Skin Disorders In Immunocompromised Diabetes Patients
Skin Disorders in Immunocompromised Diabetes Patients Immunity and diabetes is a complicated subject and many skin-related problems may be involved. From the clinicians standpoint, there are five dermatologic conditions related to immunity and diabetes that need special note: the diabetic foot, mucormycosis, necrotizing fasciitis, candidiasis, and recurrent cellulitis of the lower extremities. These illnesses seem uniquely associated with diabetic immune dysregulation. Diabetic footNecrotizing fasciitisMucormycosisCandidiasisCellulitisCandida sepsis This is a preview of subscription content, log in to check access. Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014a;70(1):e118. CrossRef Google Scholar Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers Part II. Management. J Am Acad Dermatol. 2014b;70(1):e214. CrossRef Google Scholar Al-Mutairi N, Sharma AK, Al-Sheltawi M. Cutaneous manifestations of diabetes mellitus. Study from Farwaniya hospital, Kuwait. Med Princ Pract. 2006;15(6):42730. Google Scholar Bristow I. Non-ulcerative skin pathologies of the diabetic foot. Diabetes Metab Res Rev. 2008;24 suppl 1:S849. PubMed CrossRef Google Scholar Hall JC, Hall BJ. Halls manual of skin as a marker of underlying disease. Shelton, CT, USA; 2011. p. 24560. Google Scholar Pavlovi MD, Milenkovi T, Dini M, Misovi M, Dakovi D, Todorovi S, et al. The prevalence of cutaneous manifestations in young patients with type I diabetes. Diabetes Care. 2007;30(8):19647. PubMed CrossRef Google Scholar Continue reading >>
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Type 2 Diabetes Mellitus And The Risk Of Hepatitis C Virus Infection: A Systematic Review
The aim of this study was to evaluate the relationship between type 2 diabetes mellitus (T2DM) and hepatitis C virus (HCV) infection and to examine whether T2DM enhances the risk of HCV infection compared with the risk in the general population. We followed standard guidelines to perform a meta-analysis. The associated literature was selected based on the established inclusion criteria. The summary odds ratio (OR) and 95% confidence interval (95% CI) were used to investigate the strength of the association. Through electronic database and manual searching, 22 studies were identified for the final analysis, which included a total of 78,051 individuals. Based on the random effects model, the meta-analysis results showed that patients with T2DM were at a higher risk of acquiring HCV infection than non-T2DM patients (summary OR = 3.50, 95% CI = 2.54–4.82, I2 = 82.3%). Based on the current limited evidence, this study suggests that T2DM is associated with increased susceptibility to HCV infection. Hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM) are two major public health problems associated with increasing complications and mortality rates worldwide1,2. HCV infection is a cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) in Western countries and affects an estimated total of 170 million individuals worldwide3,4. Meanwhile, Data reported by the World Health Organization (WHO) in 2000 showed that the estimated prevalence of T2DM is approximately 2.8% among adults aged over 20 years5. Both diseases present a large health care burden. Moreover, HCV infection and T2DM may coexist in an individual6. The development of HCV infection is a multi-factorial process associated with a variety of risk factors, as observed with all other Continue reading >>
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Infections In The Immunocompromised Host
Infections in the Immunocompromised Host Author: Rebecca Schreier, DO; Chief Editor: Russell W Steele, MD more... An immunocompromised host is a patient who does not have the ability to respond normally to an infection due to an impaired or weakened immune system. This inability to fight infection can be caused by a number of conditions including illness and disease (eg, diabetes, HIV), malnutrition, and drugs. Guidelines from the IDSA recommend vaccination for immunocompromised patients According to new guidelines from the Infectious Diseases Society of America (IDSA), most immunocompromised patients should be vaccinated. The new guidelines are designed for health care professionals caring for patients with compromised immune systems due to HIV infection or AIDS, cancer, solid organ transplantation, stem cell transplantation, sickle cell disease or asplenia, congenital immune deficiencies, chronic inflammatory conditions, cochlear implants, or cerebrospinal fluid leaks. [ 1 , 2 ] Specific recommendations include the following: When possible, vaccines should be administered before planned immunosuppression. Live vaccines should be administered at least 4 weeks before immunosuppression and should be avoided within 2 weeks of beginning immunosuppression. Inactivated vaccines should be administered at least 2 weeks before immunosuppression is initiated. Most immunocompromised patients 6 months of age or older should receive annual influenza vaccination as an injection; these patients should not receive live attenuated influenza vaccine administered as a nasal spray. Influenza vaccine is unlikely to be of benefit in individuals who are receiving intensive chemotherapy or who have received anti-B-cell antibodies in the preceding 6 months. Immunocompetent persons living with Continue reading >>
What Infections Are You At Risk For With Diabetes?
What Infections Are You at Risk for With Diabetes? By Heather M. Ross | Reviewed by Richard N. Fogoros, MD 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. We know healthy eating is key to help manage diabetes, but that doesn't make it easy. Our free nutrition guide is here to help. Sign up and receive your free copy! Why Are Infecti Continue reading >>
Are Diabetics Considered Immunocompromised?
What Is Cause Of Immunosupression In Diabetes Melitus?
The most common infections in diabetes patients involve the skin and urinary tract. Chronic hyperglycemia slows perfusion through blood vessels, causing nerve damage as time progresses. The skin, one of the key barriers in innate immunity, is no longer competent and lost protection against trauma and inflammation.High glucose levels limit and irregulate neutrophil synthesis, Cytosolic calcium in polymorphonuclear leukocytes (PMNs) increases in the presence of hyperglycemia and is inversely proportional to the occurrence of phagocytosis in patients with type II diabetes. High levels of cytosolic calcium inhibit the synthesis of adenosine triphosphate (ATP), which is essential for phagocytosis. The ability of PMN leukocytes to mobilize to the site of infection and stimulate of apoptosis is negatively impacted as well. Hyperglycemia causes other undesirable changes in the function of the immune system such as decreased complement response, leukocyte adherence and bactericidal activity. Chronic hyperglycemia in diabetes patients can lead to acidosis, which limits the activity of the immune system. The effects of these changes are reversible upon treatment of acidosis and hyperglycemia. Continue reading >>
How Diabetes Affects Immune System
How Diabetes affects Immune system ? Diabetes is a metabolic disorder that affects how the body uses food for energy due to insulin resistance. Diabetes affects the metabolism as well as the immune system. The disease causes the immune system to destroy insulin producing cells within the pancreas. The immune response is also much lower in people who have diabetes so they are more susceptible to getting infections that could result in the loss of a limb. Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2006, it was the seventh leading cause of death. However, diabetes is likely to be underreported as the under lying cause of death on death certifi cates. In 2004, among people ages 65 years or older, heart disease was noted on 68 percent of diabetes-related death certifi cates; stroke was noted on 16 percent of diabetes-related death certificates for the same age group. Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians—internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include a primary care provider such as an internist, a family practice doctor, or a pediatrician an endocrinologist—a specialist in diabetes care a dietitian, a nurse, and o Continue reading >>
Antibiotic Resistance Rates In Causative Agents Of Infections In Diabetic Patients
Hyperglycemia of 11.1 mmol/l (200 mg/dl) in diabetic patients leads to immune suppression of different mechanisms and should be avoided. Due to immune suppression and some diabetic complications, patients with diabetes are prone to many bacterial infections and infection recurrences, such as urinary tract infections, severe periodontitis, pneumonia, skin and soft tissue infections, including diabetic foot infections, osteomyelitis, peritonitis, sepsis and tuberculosis, and uncommon but life-threatening infections; for example, necrotizing soft tissue infections, emphysematous pyelonephritis, emphysematous cholecystitis and malignant otitis, as well as perioperative infections. The vicious cycle is that the infections can worsen the glycemic control of the diabetic patient and vice versa, the poor glycemic control or other factors associated with diabetes mellitus can facilitate the development of the infections. Due to the frequent infections or recurrences, the diabetic patients have more exposure to antibacterial agents. Immunocompromised state and frequent antibiotic use are associated with antibiotic resistance of the causative agents of the infections in these patients, such as Mycobacterium tuberculosis(according to some studies), methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Gram-negative bacteria such as Pseudomonas aeruginosaand Acinetobacter baumannii, bacteria in diabetic foot infections, and involvement of different opportunistic and rare pathogens or multidrug-resistant strains in the infections. Diabetes has been associated with elevated risk for or poor therapy of infections by antibiotic-resistant bacteria such as methicillin-resistant S. aureus, vancomycin-resistant enterococci, extended spectrum -lactamase-producing Gram-negat Continue reading >>
Are Diabetics Immunocompromised? - Usmle Forums
Both of them are IC, one the reasons is high glucose levels of the blood that alot of organisms like (ofcourse if it's poorly controlled DM), DM1 associated with mucor that's right usually the ketoacidotic patients because of the very high glucose levels. the other reason might be the angiopathy which damages the blood supply and heance the white blood cell supply to different tissues in our body hence reducing the ability to fight different infections, a big thing to remember that the integrins on endothelial cells are downregulated in diabetes which also damages the migration of neutrophils to site of infection. Another thing is the increased oxidative stress on cells in diabetes damages membranes some of this membranes are of white blood cells which become less functional. As you see there are alot of reasons - what USMLE can specifically ask you is the lack of adhesion which can be similar to Leukocyte adhesion deficiency, i also add that alcoholic patients also show the same problem with adhesion. Continue reading >>
Are Children With Type 1 Diabetes Immunocompromised?
Are children with type 1 diabetes immunocompromised? PGY-1;* Assistant Professor; Professor, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man. Copyright 2005 CMA Media Inc. or its licensors This article has been cited by other articles in PMC. In their clinical report of a 4-year-old child with leukemia and an enlarging arm lesion that proved to have been caused by an opportunistic fungus, Ahmed Mater and associates 1 state that [these i]nfections generally occur in immunocompromised patients with conditions such as neutropenia, diabetes or hematologic malignant disease. 1 This statement implies that all patients with type 1 or type 2 diabetes mellitus are immunocompromised. Our interest is children (up to 18 years of age) with type 1 diabetes, and we challenge the accuracy of the statement in this context. Mater and associates 1 cite 2 papers 2 , 3 that listed diabetes, specifically diabetes complicated by ketoacidosis, as a risk factor for opportunistic infections. However, those articles did not provide evidence to support this claim in children with type 1 diabetes. Is there any evidence to show increased rates of infection or prolonged recovery from infection in children with type 1 diabetes? In-vitro data have demonstrated impaired immune function due to hyperglycemia and/or hypoinsulinemia in association with type 1 diabetes. 4 , 5 However, those studies did not show that the differences in cell-mediated and humoral immune function translate into significant morbidity or mortality in the clinical setting. In fact, the humoral response to influenza vaccine in patients with type 1 diabetes is no different from that of controls with respect to protection rates. 6 The incidence of candidal infection is greater among patients with type Continue reading >>
Diabetes Exacerbates Infection Via Hyperinflammation By Signaling Through Tlr4 And Rage
ABSTRACT For more than a century, diabetic patients have been considered immunosuppressed due to defects in phagocytosis and microbial killing. We confirmed that diabetic mice were hypersusceptible to bacteremia caused by Gram-negative bacteria (GNB), dying at inocula nonlethal to nondiabetic mice. Contrary to the pervasive paradigm that diabetes impedes phagocytic function, the bacterial burden was no greater in diabetic mice despite excess mortality. However, diabetic mice did exhibit dramatically increased levels of proinflammatory cytokines in response to GNB infections, and immunosuppressing these cytokines with dexamethasone restored their resistance to infection, both of which are consistent with excess inflammation. Furthermore, disruption of the receptor for advanced glycation end products (RAGE), which is stimulated by heightened levels of AGEs in diabetic hosts, protected diabetic but not nondiabetic mice from GNB infection. Thus, rather than immunosuppression, diabetes drives lethal hyperinflammation in response to GNB by signaling through RAGE. As such, interventions to improve the outcomes from GNB infections should seek to suppress the immune response in diabetic hosts. IMPORTANCE Physicians and scientists have subscribed to the dogma that diabetes predisposes the host to worse outcomes from infections because it suppresses the immune system. This understanding was based largely on ex vivo studies of blood from patients and animals with diabetes. However, we have found that the opposite is true and worse outcomes from infection are caused by overstimulation of the immune system in response to bacteria. This overreaction occurs by simultaneous ligation of two host receptors: TLR4 and RAGE. Both signal via a common downstream messenger, MyD88, triggering hy Continue reading >>
The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment. Overview Goals The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies. The targets are: HbA1c of 6% to 7.0% Preprandial blood Continue reading >>