Infectious complications of diabetes

Through different mechanisms, diabetes increases the risk of infections, whether viral, bacterial or fungal. And in turn, infections can lead to an imbalance of diabetes. In order to break this vicious circle which can have serious consequences, it is necessary to treat them quickly and know how to prevent them. Explanations with Professor Ariane Sultan, endocrinologist.

It is now proven that diabetes , whether type 1 or type 2 , is associated with an increased risk of infections. Recently, British researchers 1 showed that 6% of hospitalizations and 12% of deaths related to an infection are attributable to diabetes, due to major complications.




The most common infections in diabetes

This increased risk concerns infections of viral, bacterial and fungal origin , throughout the body. “ In terms of relative risk compared to a non-diabetic person, the main infections in people with diabetes are respiratory infections , urinary tract infections and osteoarticular infections with in particular the problem of the diabetic foot , explains Professor Ariane Sultan, endocrinologist. The risk appears from a young age: a 40-year-old diabetic has 4 times more risk than a non-diabetic of contracting an infection in the foot, for example ,” she specifies.

Influenza , otitis  or mycosis are therefore all conditions to which the diabetic population is particularly exposed, and whose frequency remains poorly explained.

Several infectious risk factors

Indeed, the mechanism of this association is not well known. " But there are probably a number of abnormalities in the immune cells of patients with diabetes ," suggests Professor Sultan. Abnormalities which prove to be all the more deleterious when:

  • The patient is elderly , immunosenescence (aging and loss of efficiency of the immune system) making him more susceptible to infections;
  • The patient has comorbidities , such as heart or kidney problems  ;
  • Diabetes is unbalanced , with chronic hyperglycaemia " probably having a role in promoting bacterial overgrowth ".

  • Prevent and treat infectious complications of diabetes

    More serious infections

    It is important to quickly treat infections in diabetics, which are not only more frequent " but also more serious with a risk of complications and more frequent recourse to hospitalization; the same is true for the mortality linked to these infections " , underlines Professor Sultan. Thus, the flu can more often be complicated by  pneumonia and lead to sometimes fatal respiratory distress; urinary tract infections in emphysematous cystitis (presence of gas in the bladder wall or lumen) or papillary necrosis  ; and we know that more than 26,700 diabetics were hospitalized for a foot wound and more than 8,400 for a lower limb amputation in France in 20162 .

    worsening of diabetes

    In addition, the presence of an infection can itself aggravate diabetes, since it contributes to its imbalance: by acting on hyperglycemic hormones, it will increase insulin requirements 3 . “ We can detect an infection, or in any case its first signs, on a glycemic imbalance , says Pr Sultan:  if we go for example from 1 g/l to 3 g/l, we have to look for something ”. On the other hand, recurrent infections can sometimes put the doctor on the track of diabetes.

    Special treatment and prevention

    If the infection will be treated according to the germ responsible as in the non-diabetic person, for the diabetic patient the balance of the diabetes (which can pass by the improvement of the food and/or a reinforcement of the medicinal treatment) also makes integral part of the treatment. It is also one of the infection prevention measures that must be strictly observed, in the same way as:

    • The adoption of good personal hygiene  : regular hand washing, daily shower, change of socks and underwear every day;
    • Regular medical follow-up, particularly oral  : periodontal disease is more common in diabetics and " providers of falling teeth and broken teeth ";
    • Vaccination: the flu vaccine and the vaccine against pneumococcal  infections (otitis, sinusitis, pneumonia, septicemia, meningitis) are recommended in the diabetic population. " In terms of reducing the risk of infection, we have data to say that vaccination is almost as effective in non-diabetics as in diabetics ", specifies Professor Sultan. The  flu vaccine, to be renewed every year, is 100% covered for people with diabetes  ; the pneumococcal vaccine is reimbursed at 65%.
Location: India

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