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Epidemiology
Diabetes and the Risk of Infection: A National Cohort Study
Eun Jin Kim, Kyoung Hwa Ha, Dae Jung Kim, Young Hwa Choi
Diabetes Metab J. 2019;43(6):804-814.   Published online October 21, 2019
DOI: https://doi.org/10.4093/dmj.2019.0071
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Several studies have shown that people with diabetes are vulnerable to infection. This study compared the risk of infection-related hospitalizations, intensive care unit (ICU) admission, and deaths between the person with diabetes and the general population in South Korea.

Methods

We conducted a cohort study of 66,426 diabetes and 132,852 age-sex-region-matched non-diabetes controls from the general population using a sample of data from the National Health Insurance Service-National Sample Cohort. The cohort was followed up for 9 years. Infections were classified into 17 separate categories. We used Poisson regression, with adjustment for household income and other comorbidities, to estimate incidence rate ratios (IRRs) in order to compare of infection-related hospitalizations, ICU admissions, and deaths.

Results

Compared to non-diabetes controls, diabetes group had a greater risk of almost all the types of infections considered, with the adjusted IRRs (aIRRs) for infection-related hospitalizations being the highest for hepatic abscess (aIRR, 10.17; 95% confidence interval [CI], 7.04 to 14.67), central nervous system (CNS) infections (aIRR, 8.72; 95% CI, 6.64 to 11.45), and skin and soft tissue infections other than cellulitis (SSTIs) (aIRR, 3.52; 95% CI, 3.20 to 3.88). Diabetes group also had a greater risk of ICU admission and death due to SSTIs (aIRR, 11.75; 95% CI, 7.32 to 18.86), CNS infections (aIRR, 5.25; 95% CI, 3.53 to 7.79), and bone and joint infections (aIRR, 4.78; 95% CI, 3.09 to 7.39).

Conclusion

In South Korea, people with diabetes has a considerably higher incidence of infection-related hospitalizations and deaths than the general population.

Citations

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Review
Functional and Mechanistic Integration of Infection and the Metabolic Syndrome
Peter Sommer, Gary Sweeney
Korean Diabetes J. 2010;34(2):71-76.   Published online April 30, 2010
DOI: https://doi.org/10.4093/kdj.2010.34.2.71
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  • 30 Download
  • 15 Crossref
AbstractAbstract PDFPubReader   

The metabolic syndrome refers to a well defined group of risk factors, including central obesity and inflammation, for the development of diabetes and cardiovascular disease. Interestingly, many studies have recently led to the emergence of somewhat unexpected relationships between several infectious diseases and various aspects of the metabolic syndrome. Our understanding of the mechanisms underlying these interactions is also rapidly developing and some of these are summarized in this article. We will focus first on bacterial infection, and most notably the role of gut microbiota in regulaton of both obesity and inflammation. In particular, we focus on the role of inflammasomes and propose that understanding the role of Toll-like receptors and Nod-like receptors in the pathogenesis of inflammatory disorders with or without infection may provide novel targets for prevention and/or treatment of associated diseases. Secondly, chronic bacterial or viral infection and emerging links with metabolism will be reviewed. Finally, consideratons of biomarkers for metabolic syndrome, in particular lipocalin-2, and their link with infection will be discussed.

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Original Article
Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot.
Bong Yun Cha, Hyun Shik Son, Jung Min Lee, Sung Koo Kang
Korean Diabetes J. 2006;30(1):64-72.   Published online January 1, 2006
DOI: https://doi.org/10.4093/jkda.2006.30.1.64
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AbstractAbstract PDF
BACKGROUND
The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed by a dermatologist. RESULTS: 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease was found in 10,403 patients that constituted 78.4%(48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496(29.9%), onychomycosis in 7,783(35.9%), and coexistence was in 3,883(17.9%). Foot deformity was in 1,346(6.2% of diabetics; 10.1% of foot disease), nonpalpable pulse in 1,051 (4.8%; 7.9%), and foot ulcer was in 425(2.0%; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid visit to the department of dermatology. Of these, 4,519 patient were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population were comprised of 2,272 males and 2,247 females, showing similar prevalences between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847(70%) and onychomycosis was proven mycologically in 3,276 patients. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885 (70.8%) and tinea pedis was found in 3,209(58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

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