In a comprehensive study published in Diabetes Care, Lipska et al. examined the relationship between glycemic control and infection-related hospitalization risk in older adults with type 2 diabetes. The findings provide nuanced insights into the balance between intensive and relaxed glycemic targets, particularly as clinical guidelines evolve to prioritize individualized care.
Study Objectives and Design
The research aimed to compare the risk of infection-related hospitalizations in adults aged ≥65 years with type 2 diabetes, based on different levels of glycemic control. Using data from an integrated healthcare delivery system, the study evaluated three HbA1c categories:
• Intensive control: HbA1c 6% to <7%
• Moderately relaxed control: HbA1c 7% to <8%
• Relaxed control: HbA1c 8% to <9%
The study analyzed 103,242 patients and employed negative binomial models to assess incidence rates and relative risks for various infections, including respiratory, genitourinary, skin/soft tissue/bone infections, and sepsis.
Key Findings
1. Overall Risk of Infection:
• The average rate of hospitalization for infections was 51.3 per 1,000 person-years.
2. Impact of Relaxed Glycemic Control:
• Compared to HbA1c 6% to <7%, the unadjusted risk of hospitalization for infections was:
• Significantly elevated for HbA1c 8% to <9% (RR 1.25; 95% CI 1.13–1.39).
• Not significantly different for HbA1c 7% to <8% (RR 0.99; 95% CI 0.91–1.08).
3. Infection Type-Specific Risk:
• After adjustment, HbA1c 8% to <9% was significantly associated with increased risk only for skin, soft tissue, and bone infections (adjusted RR 1.33; 95% CI 1.05–1.69).
• Other infection categories showed no significant association with relaxed glycemic targets.
Conclusions
The findings suggest that while relaxed glycemic control levels (HbA1c 7% to <8%) recommended by current guidelines do not increase the overall risk of infection-related hospitalizations, HbA1c levels approaching 9% may heighten the risk for certain infection types, notably skin and soft tissue infections.
Clinical Implications
This study reinforces the importance of individualized glycemic targets in older adults with diabetes. Moderately relaxed control appears safe for most patients, but close monitoring may be warranted for those with HbA1c levels nearing 9%, particularly to prevent skin-related infections.
For further details, read the full manuscript here.
Citation: Lipska KJ, Gilliam LK, et al., “Risk of Infection in Older Adults With Type 2 Diabetes With Relaxed Glycemic Control,” Diabetes Care, 2024;47(12):2258–2265. https://doi.org/10.2337/dc24-1612
This research provides a valuable framework for clinicians aiming to strike the optimal balance between glycemic control and infection risk in older adults, contributing to safer and more effective diabetes management.
Leave a Reply