Risk of Infection in Older Adults with Type 2 Diabetes with Relaxed Glycemic Control

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posted on 2024-10-22, 16:00 authored by Kasia J. Lipska, Lisa K. Gilliam, Catherine Lee, Jennifer Y. Liu, Vincent X. Liu, Howard H. Moffet, Melissa M. Parker, Heidi Zapata, Andrew J. Karter

OBJECTIVE. To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control.

RESEARCH DESIGN AND METHODS. Retrospective cohort study of adults ≥65 years old with type 2 diabetes from an integrated healthcare delivery system. Negative binomial models were used to estimate incidence rates and relative risk (RR) of hospitalization for infections (respiratory; genitourinary; skin, soft tissue and bone; and sepsis) comparing 2 levels of relaxed (HbA1c 7% to <8% and 8% to <9%) with intensive (HbA1c 6 to <7%) glycemic control from 1/1/2019 to 3/1/2020.

RESULTS. Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% 7% to <8%, and 16.1% 8% to <9%), the rate of hospitalization for infections was 51.3 per 1000 person-years. Compared with HbA1c 6% to <7%, unadjusted risk of hospitalization for infections was significantly elevated among patients with HbA1c 8% to <9% (RR 1.25, 95% CI 1.13-1.39) but not among patients with HbA1c 7% to <8% (RR 0.99, 95% CI 0.91-1.08), and the difference became non-significant after adjustment. Across categories of infections, the adjusted RR of hospitalization was significantly higher among patients with HbA1c 8% to <9% only for skin, soft tissue, and bone infection (RR 1.33, 95% CI 1.05-1.69).

CONCLUSIONS. Older patients with type 2 diabetes who achieve relaxed glycemic control levels endorsed by clinical guidelines are not at significantly increased risk of hospitalization for most infections but HbA1c 8% to <9% is associated with increased risk of hospitalization for skin, soft tissue, and bone infections.