Tel Aviv, Israel—Diabetes patients are known to be at higher risk of common infections, including cellulitis and pneumonia. What is less clear is how the level of glycemic control correlated with the rate of infection.

A study published by Diabetes Care examined the association between glycemic control in patients with diabetes and the incidence of infection in the entire population of patients with diabetes in a large health-maintenance association. Israeli researchers documented hemoglobin A1c levels for each patients and then searched for an infection diagnosis in the 60 days that followed the test.

The authors say they identified 407 cases of cellulitis, and multivariate logistic regressions for cellulitis demonstrated a 1.4-fold increased risk among patients with HbA1c of greater than 7.5% (58 mmol/mol). The study explains that obesity, Parkinson’s disease, peripheral vascular disease, and prior treatment with prednisone all predisposed certain patients to cellulitis.

Overall, researchers calculate a 12% increase in the odds of cellulitis for every 1% (11 mmol/mol) elevation in HbA1c (odds ratio [OR] 1.12; CI, 1.05-1.19). A similar analysis showed a trend toward an increased risk of pneumonia in patients with HbA1c >7.5% (58 mmol/mol) (OR 1.1; CI 0.9-1.4), they add.

“Poor glycemic control was associated in this study with the development of cellulitis. The study also suggests that exposure to oral prednisolone increases the risk of cellulitis, pneumonia, and upper respiratory infection,” the authors conclude.

According to a review last year in Archives of Microbiology, “Diabetes mellitus is associated with various types of infections notably skin, mucous membrane, soft tissue, urinary tract, respiratory tract and surgical and/or hospital-associated infections. The reason behind this frequent association with infections is an immunocompromised state of the diabetic patient because uncontrolled hyperglycemia impairs overall immunity of the diabetic patient via involvement of various mechanistic pathways that lead to the diabetic patient as immunocompromised.”

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