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Diabetes and Insulin Therapy are associated with Increased Risk of Hospitalization for Infection but not Mortality: A Longitudinal Cohort Study.

BACKGROUND
Epidemiologic and experimental evidence suggests that individuals with diabetes are at increased risk of infection. We sought to examine the association of diabetes and insulin therapy with hospitalization for infection and 28-day mortality.


METHODS
We performed a prospective cohort study using data from 30,239 community-dwelling participants aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. We defined diabetes as fasting glucose ≥126 mg/L (or glucose ≥200 mg/L for those not fasting), the use of insulin or oral hypoglycemic agents, or self-reported history. We identified infection-related hospitalizations over 2003-2012. We fit Cox proportional hazards models to assess the association of diabetes with hazard rates of infection and logistic regression models for 28-day mortality.


RESULTS
Among 29,683 REGARDS patients with complete follow-up, 7,375 had diabetes. Over a median follow-up period of 6.5 years, we identified 2,593 first and 3,411 total infection hospitalizations. In adjusted analyses, participants with diabetes had increased hazard of infection (hazard ratio [HR] 1.50; 95% confidence interval [CI]: 1.37-1.64) compared to those without diabetes. Participants with diabetes hospitalized for infection did not have increased odds of 28-day mortality (odds ratio [OR] 0.94; CI: 0.67-1.32). Participants receiving insulin therapy had greater hazard of infection (HR 2.18; CI: 1.90-2.51), but no increased odds of mortality (OR 1.07; CI: 0.67-1.71).


CONCLUSIONS
Diabetes is associated with increased risk of hospitalization for infection. However, we did not find an association with 28-day mortality. Insulin therapy conferred an even greater risk of hospitalization, without increased mortality.