OBJECTIVE We describe in detail the burden of infections in adults with diabetes within a large national population cohort. We also compare infection rates between patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM).

RESEARCH DESIGN AND METHODS A retrospective cohort study compared 102,493 English primary care patients aged 40–89 years with a diabetes diagnosis by 2008 (n = 5,863 T1DM and n = 96,630 T2DM) with 203,518 age-sex-practice–matched control subjects without diabetes. Infection rates during 2008–2015, compiled from primary care and linked hospital and mortality records, were compared across 19 individual infection categories. These were further summarized as any requiring a prescription or hospitalization or as cause of death. Poisson regression was used to estimate incidence rate ratios (IRRs) between 1) people with diabetes and control subjects and 2) T1DM and T2DM adjusted for age, sex, smoking, BMI, and deprivation.

RESULTS Compared with control subjects without diabetes, patients with diabetes had higher rates for all infections, with the highest IRRs seen for bone and joint infections, sepsis, and cellulitis. IRRs for infection-related hospitalizations were 3.71 (95% CI 3.27–4.21) for T1DM and 1.88 (95% CI 1.83–1.92) for T2DM. A direct comparison of types confirmed higher adjusted risks for T1DM versus T2DM (death from infection IRR 2.19 [95% CI 1.75–2.74]). We estimate that 6% of infection-related hospitalizations and 12% of infection-related deaths were attributable to diabetes.

CONCLUSIONS People with diabetes, particularly T1DM, are at increased risk of serious infection, representing an important population burden. Strategies that reduce the risk of developing severe infections and poor treatment outcomes are under-researched and should be explored.

目的我们详细描述了成年人口人群中成年人的糖尿病感染负担。我们还比较了1型和2型糖尿病（T1DM和T2DM）患者之间的感染率。

研究设计和方法一项回顾性队列研究比较了截至2008年102,493名40-89岁，诊断为糖尿病的英国初级保健患者（n = 5,863 T1DM和n = 96,630 T2DM）与203,518名与年龄相匹配的无糖尿病对照受试者。根据初级卫生保健以及相关的医院和死亡率记录汇总了2008-2015年期间的感染率，比较了19种个体感染类别。这些被进一步概括为需要处方或住院或导致死亡的原因。使用Poisson回归来估计1）糖尿病患者和控制对象与2）根据年龄，性别，吸烟，BMI和剥夺调整的T1DM和T2DM之间的发生率比（IRR）。

结果与无糖尿病的对照组相比，糖尿病患者的所有感染率更高，其骨关节感染，败血症和蜂窝织炎的IRR最高。T1DM与感染相关住院的IRR为3.71（95％CI 3.27–4.21），T2DM为1.88（95％CI 1.83–1.92）。对类型的直接比较证实，T1DM和T2DM的调整风险更高（感染IRR 2.19 [95％CI 1.75–2.74]导致的死亡）。我们估计，与感染有关的住院治疗中有6％与与感染有关的死亡中有12％与糖尿病有关。

结论糖尿病患者，特别是T1DM患者，发生严重感染的风险增加，这代表着重要的人口负担。降低严重感染风险和治疗效果差的策略的研究仍在研究中，应加以探索。