Older type 2 diabetes patients with HbA1c 8% to <9% have a 33% higher chances of being hospitalized for skin, soft tissue, and bone infections compared to those with HbA1c levels between 6% and <7%, according to a study published Oct. 22, 2024 in the journal Diabetes Care.1
The retrospective cohort study enrolled adults aged 65 and older with type 2 diabetes, from January 2019 to March 2020, to compare the risk of hospitalization for respiratory, genitourinary infections, skin and soft tissue infections, sepsis and infection of the bone, between those who achieved intensive glycemic control and those who followed a more relaxed approach. Two levels of relaxed HbA1c 7% to <8% and 8% to <9%) were compared with intensive (HbA1c 6% to <7%) glycemic control.
Out of the 103,242 patients included in the study, 48.5% had HbA1c levels between 6% and <7%, 35.3% had HbA1c levels between 7% and <8% and 16.1% had HbA1c levels between 8% and <9%. The overall rate of hospitalization for infections was 51.3 per 1,000 person-years.
For the HbA1c 8% to <9% group, the unadjusted relative risk (RR) of hospitalization for infections was significantly raised compared to the HbA1c 6% to <7% group, with a relative risk of 1.25. But there was no significant increase in risk of infection in the HbA1c 7% to <8% group, with a relative risk of 0.99, suggesting no major difference compared to the 6% to <7% group. However, after adjusting for confounding factors such as demographics, comorbidities, diabetes medications, microvascular complications, the elevated risk in the HbA1c 8% to <9% group became nonsignificant.
The study shows that older adults with type 2 diabetes who maintain relaxed glycemic control (HbA1c levels 7% to <8%) do not face a significantly increased risk of hospitalization for most types of infections compared to those with more stringent control (HbA1c 6% to <7%). In the 7 to <8% group, the RR for respiratory infections was 0.85, for genitourinary infections, it was 1.01, for skin soft tissue and bone, it was 1.10 and sepsis, it was 1.02. However, a higher risk of skin, soft tissue, and bone infections was observed among those with higher HbA1c levels ranging from 8% to <9%, where the RR for respiratory infections was 0.90, for genitourinary infections, it was 0.93, for sepsis, it was 1.03 and for skin soft tissue and bone infection, it was 1.33.
These findings therefore suggest that a less aggressive glycemic control to avoid the risks associated with intensive control such as hypoglycemia in older patients with type 2 diabetes is a feasible strategy and is consistent with the recommendations of guidelines that advocate a more moderate glycemic control in this age group.
Reference
1. Kasia J Lipska, et al. Risk of infection in older adults with type 2 diabetes with relaxed glycemic control. Diabetes Care. 2024 Oct 22:dc241612. doi: 10.2337/dc24-1612.