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Why Do Diabetics Get More Infections?

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

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 >>

What Infections Are You At Risk For With Diabetes?

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 >>

Diabetes And Urinary Tract Infections

Diabetes And Urinary Tract Infections

People whose diabetes is not properly controlled have twice the risk of developing infections. In addition to diabetes, you could be more susceptible to urinary tract infections if: Your blood glucose (sugar) levels are not properly controlled. Sugar in the urine promotes bacterial growth. Your nervous system is already affected by diabetes (neuropathy). You could have a “lazy bladder” that does not empty completely. You are a woman. Certain anatomical traits, such as having a shorter urethra, increase the risk of bacterial contamination. You already have diabetes complications in your kidneys or blood vessels. This could be a sign that your diabetes is not properly controlled. You have had a urinary tract infection within the last year. People who have had infections within the last year are more at risk of a recurrence. When to consult? To avoid urinary tract infections, consult your doctor if one or more of these symptoms occur: Fever More frequent urination Burning sensation when urinating Urine has an unpleasant odour False urge to urinate Blood in the urine Abdominal pain when urinating Prevention As is the case for all types of infections if you have diabetes, it is crucial that you maintain your blood glucose (sugar) levels within the target range. Wash your hands often. Do not ignore the urge to urinate. Be sure to stay well hydrated. Quit smoking if you are a smoker. What about cranberry juice? Although studies on cranberry juice seem promising, none has clearly shown that cranberry juice can be used to treat or prevent urinary tract infections. If you nevertheless decide to drink cranberry juice, be aware of the amount of sugar in the juice or cocktail, especially if you are diabetic. Research and text: Diabetes Québec Team of Health Care Professionals S Continue reading >>

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

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 >>

Infection In Patients With Diabetes Mellitus

Infection In Patients With Diabetes Mellitus

Infection in Patients With Diabetes Mellitus Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Diabetes increases susceptibility to various types of infections. The most common sites of infection in diabetic patients are the skin and urinary tract. 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. 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. Sensory neuropathy, atherosclerotic vascular disease, Continue reading >>

What You Need To Know About Utis

What You Need To Know About Utis

Burning when you urinate. A frequent urge to urinate. Pain in your back or abdomen. Do any of these symptoms sound familiar? These are all symptoms of a urinary tract infection, or UTI, for short. Studies show that people with Type 2 diabetes have a greater risk of getting a UTI than people without diabetes. Despite the fact that UTIs are all too common and downright annoying, they can also lead to more serious situations if they’re not caught and treated. What is a UTI, anyway? A UTI is an infection in your urinary tract. Your urinary tract includes your kidneys, bladder, ureters, urethra, and, in men, prostate. Most UTIs occur in your bladder, the organ that stores your urine. What causes a UTI? A UTI is caused by bacteria, usually from the bowels. Normally, the urinary tract system has safeguards to protect against infection. For example, the ureters, which are the tubes that carry urine from the kidneys to the bladder, have one-way valves to prevent urine from backing up into the kidneys. The process of emptying your bladder (called urination) also helps to flush out bacteria and other microbes. And a healthy immune system helps protect against infection, as well. Why are UTIs more common in people with diabetes? UTIs are the second most common type of infection. Women are 10 times more likely to get a UTI than men because of their anatomy. In fact, more than 50% of women will have a UTI at some point in their lives. If you’re a woman with Type 2 diabetes, your risk may be even higher, according to two recent studies. In one study, 9% of the subjects with diabetes had UTIs compared with 6% of those without diabetes. And the second study showed that people with diabetes had a 60% higher risk of getting a UTI compared to those without diabetes. Why are people with Continue reading >>

Diabetes And Infections

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

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 >>

Diabetes Mellitus And Infectious Diseases: Controlling Chronic Hyperglycemia

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 >>

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

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 And Urinary Tract Infections – Things You Need To Know

Diabetes And Urinary Tract Infections – Things You Need To Know

In this article we will cover everything you need to know about diabetes and your risk for Urinary Tract Infections. Do you have an increased risk of Urinary Tract Infections now that you have diabetes? We will cover what a Urinary Tract Infection is, symptoms, diagnosis and treatment guidelines, as well as why they are more common in people with diabetes. More importantly, we will discuss steps you can take to prevent them! What Is a Urinary Tract Infection (UTI)? A urinary tract infection or UTI is an infection anywhere in your bladder, kidneys or in the urinary system. An infection of the upper urinary tract or the bladder is called a bladder infection or cystitis. An infection in the urethra is called urethritis. Women tend to be more at risk of these types of infections due to their anatomy; they have a much shorter area between the urethra and the opening to the urethra to the bladder. Urinary tract infections are rare in men under 50 due to their anatomy. A more serious infection of the lower urinary tract is an infection of the kidney and the ureters and is called pyelonephritis. This is a complication and occurs when the bladder infection progresses to the kidneys. I highly advise reading the following articles: According to the Stanford Medicine’s Michael Hsieh Lab, half of women and men will have experienced a urinary tract infection (UTI) during our lifetime at least once. They are the most common infection, and can lead to death in patients who are experiencing it severely. Antibiotics are the most effective therapy.The National Institute of Diabetes and Digestive and Kidney Diseases account 8.1 million visits to the clinic, hospitals for UTI purposes. For women, the risk of getting a UTI is 50 percent greater than a man. What Are The Symptoms of a UTI? L Continue reading >>

Diabetes Mellitus And Infection

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 >>

Diabetes And Feminine Health: What Women Need To Know

Diabetes And Feminine Health: What Women Need To Know

Anyone who has experienced a yeast infection knows how unpleasant the condition can be. Abnormal vaginal discharge, itching and burning, painful intercourse and urination, and redness and swelling — any of these common symptoms can put a dent in a woman’s sex life or simply impact her daily comfort level. For women with type 2 diabetes, combating this issue and maintaining feminine health overall can be of particular concern, especially if their blood sugar is poorly controlled. A Greater Risk of Yeast Infections “Control of blood sugars is important for the whole body,” says Mache Seibel, MD, a gynecologist and obstetrician at Harvard Medical School in Boston. “But an area that isn’t much talked about is how elevated blood sugars seep into vaginal tissues and set up an environment that’s more favorable for yeast infections.” Vaginal tissue contains a balance of microorganisms, like yeast and bacteria, Dr. Seibel explains, but excess sugar in the blood can fuel the growth of yeast, potentially leading to an infection. “Think about baking bread and how yeast thrives much better when you add sugar,” says Susan Renda, CDE, doctor of nursing practice and assistant professor in the department of community–public health at Johns Hopkins University School of Nursing in Baltimore. “I tell patients, ‘You have a nice little balance in your body, but when you throw a cake and cookie party, all the yeast comes to the party and just starts to go nuts.’” Frequent urination, which can occur when glucose levels are high and the body works to rid itself of excess sugar, can add to the problem by bringing additional sugar found in the urine to the vaginal area. Certain diabetes drugs, such as canagliflozin (Invokana, Invokamet, or Invokamet XR), an SGLT-2 in Continue reading >>

Diabetes And The Risk Of Acute Urinary Tract Infection Among Postmenopausal Women

Diabetes And The Risk Of Acute Urinary Tract Infection Among Postmenopausal Women

OBJECTIVE—To examine whether the presence of diabetes alters the risk of acute urinary tract infection (UTI) in postmenopausal women. RESEARCH DESIGN AND METHODS—A case-control study of the Group Health Cooperative of Puget Sound (GHC), a staff-model nonprofit health maintenance organization in Washington State, was conducted. Subjects were women aged 55–75 years who had been members of GHC for at least 1 year and who had had an acute symptomatic UTI within the preceding month. Laboratory files were used to identify women with a urine culture that grew ≥105 colonies of a urinary pathogen. Medical records were reviewed to confirm the presence of acute, clinically symptomatic UTI. Control subjects were randomly selected from the GHC enrollment file, screened to remove women with recent UTI, and frequency matched to cases by age within 2 years. An interviewer ascertained self-reported clinician-diagnosed diabetes. Diagnosis of diabetes was confirmed by the GHC diabetes registry. A subsample of women underwent measurement of postvoid residual bladder volume (n = 748) and culture of vaginal flora (n = 454). RESULTS—Of the 901 case and 913 control subjects, diabetes was reported in 13.1 and 6.8%, respectively. The health plan diabetes registry confirmed the diagnosis in 92% of women who self-reported the condition. The age-adjusted odds ratio (OR) for UTI in relation to self-reported clinician-diagnosed diabetes was 2.2 (95% CI 1.6–3.0). Adjustment for frequency of sexual intercourse and history of UTI had little effect on this estimate. Compared with nondiabetic women, higher UTI odds were seen in subjects who used oral hypoglycemic agents (OR 2.9 [95% CI 1.7–5.1]) and insulin (2.6 [1.5–4.6]) but not in subjects with untreated diabetes or diabetes treated by Continue reading >>

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

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 >>

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