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1 August 2005

Volume 41, Number 3
Clinical Infectious Diseases 2005;41:281–288
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4103-0001$15.00
DOI: 10.1086/431587
MAJOR ARTICLE

Increased Risk of Common Infections in Patients with Type 1 and Type 2 Diabetes Mellitus

L. M. A. J. Muller,1

K. J. Gorter,1

E. Hak,1

W. L. Goudzwaard,1

F. G. Schellevis,3

A. I. M. Hoepelman,2 and

G. E. H. M. Rutten1

1Julius Center for Health Sciences and Primary Care and 2Department of Medicine, Division of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, and 3Netherlands Institute for Health Services Research NIVEL, Utrecht, The Netherlands

Background.Clinical data on the association of diabetes mellitus with common infections are virtually lacking, not conclusive, and often biased. We intended to determine the relative risks of common infections in patients with type 1 and type 2 diabetes mellitus (DM1 and DM2, respectively).

Methods.In a 12‐month prospective cohort study conducted as part of the Second Dutch National Survey of General Practice, we compared 705 adult patients who had DM1 and 6712 adult patients who had DM2 with 18,911 control patients who had hypertension without diabetes. Outcome measures were medically attended episodes of infection of the respiratory tract, urinary tract, and skin and mucous membranes. We applied multivariable and polytomous logistic regression analysis to determine independent risks of infections and their recurrences in patients with diabetes, compared with control patients.

Results.Upper respiratory infections were equally common among patients with diabetes and control patients. Patients with diabetes had a greater risk of lower respiratory tract infection (for patients with DM1: adjusted odds ratio [AOR], 1.42 [95% confidence interval {CI}, 0.96–2.08]; for patients with DM2: AOR, 1.32 [95% CI, 1.13–1.53]), urinary tract infection (for patients with DM1: AOR, 1.96 [95% CI, 1.49–2.58]; for patients with DM2: AOR, 1.24 [95% CI, 1.10–1.39]), bacterial skin and mucous membrane infection (for patients with DM1: AOR, 1.59 [95% CI, 1.12–2.24]; for patients with DM2: AOR, 1.33 [95% CI, 1.15–1.54]), and mycotic skin and mucous membrane infection (for patients with DM1: AOR, 1.34 [95% CI, 0.97–1.84]; for patients with DM2: AOR, 1.44 [95% CI, 1.27–1.63]). Risks increased with recurrences of common infections.

Conclusions.Patients with DM1 and DM2 are at increased risk for lower respiratory tract infection, urinary tract infection, and skin and mucous membrane infection. Studies are warranted into management of such infections in patients with diabetes.

Received 14 December 2004; accepted 8 March 2005; electronically published 16 June 2005.

  • (See the editorial commentary by Jackson on pages 289–90)

Reprints or correspondence: Dr. L. Muller, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO Box 85060, 3508 AB Utrecht, The Netherlands ().

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