The Hidden Link Between Type 2 Diabetes and Infections in Older Adults
When we think of complications from type 2 diabetes, heart disease, neuropathy, and kidney issues frequently enough come to mind. But what about infections? According to Kasia Lipska, MD, MHS, an associate professor at Yale School of Medicine, infections are a important yet overlooked risk for older adults with diabetes. In her recent research, Lipska sheds light on how diabetes impacts the immune system and the risks of hospitalization due to infections.
How Diabetes Weakens the Immune system
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Diabetes doesn’t just affect blood sugar—it also compromises the body’s ability to fight infections. “High blood sugar impairs the function of the body’s white cells, making it harder for the immune system to fight off infection,” explains lipska. Additionally, complications like neuropathy and peripheral vascular disease can lead to foot wounds, which, combined with poor blood flow, make healing tough. This dual challenge of high blood sugar and impaired circulation creates a perfect storm for infections.
The Risk of Infection in Older Adults with Diabetes
For older adults, managing diabetes requires a delicate balance. Current guidelines recommend more relaxed glycemic control for this population to avoid the dangers of low blood sugar.But does this approach increase the risk of infections? Lipska’s study aimed to answer this question by examining the relationship between A1C levels and hospitalization rates for infections.
The study divided participants into three A1C ranges: 6-7%, 7-8%, and 8-9%. Researchers then analyzed the risk of hospitalization for four types of infections: respiratory, genitourinary, skin/soft tissue/bone, and sepsis. The findings were surprising. While higher A1C levels (8-9%) were not linked to a significant increase in hospitalization for most infections, they were associated with a 33% higher risk of skin, soft tissue, and bone infections.
What This Means for Older Patients
For Lipska, these findings underscore the importance of individualized care. “In my older patients, where it doesn’t make clinical sense to control their blood sugars very tightly, I will try to hit the 7 to 8 percent range,” she says. However, for patients at risk of low blood sugar or those undergoing transitions like moving to a nursing home, the benefits of looser control may outweigh the risks.
The COVID-19 pandemic has highlighted the interconnectedness of chronic diseases and infectious risks.“Given that diabetes raises this risk, more studies need to be done to better understand that relationship,” Lipska emphasizes. This research could inform not only medication choices but also optimal glycemic control levels for individuals.
Key Takeaways
| A1C Range | risk of Hospitalization for Infections |
|—————|——————————————–|
| 6-7% | No significant increase |
| 7-8% | No significant increase |
| 8-9% | 33% higher risk of skin/soft tissue/bone infections |
As we continue to navigate the complexities of diabetes management, studies like Lipska’s remind us of the importance of balancing risks and benefits, especially for older adults. For more insights into diabetes and metabolic health, visit Yale’s Section of Endocrinology and Metabolism.
Understanding the hidden risks of diabetes is crucial. by staying informed, we can make better decisions for our health and the health of our loved ones.
When we think of complications from type 2 diabetes, heart disease, neuropathy, and kidney issues frequently come to mind. But what about infections? according to kasia Lipska, MD, MHS, an associate professor at Yale School of Medicine, infections are an critically important yet overlooked risk for older adults with diabetes. In her recent research, Lipska sheds light on how diabetes impacts the immune system and the risks of hospitalization due to infections. To dive deeper into this critical topic, we sat down with Dr. Erica Martinez, a leading endocrinologist and diabetes specialist, for an insightful conversation.
Understanding How Diabetes weakens the Immune System
Editor: Dr. martinez, could you explain why people with diabetes are more susceptible to infections?
Dr. Martinez: Absolutely. Diabetes doesn’t just affect blood sugar—it also compromises the body’s ability to fight infections. High blood sugar impairs the function of white blood cells, which are essential for combating pathogens. Additionally, diabetes-related complications like neuropathy and peripheral vascular disease can lead to wounds, notably in the feet. Poor blood flow makes it harder for these wounds to heal, creating a perfect storm for infections.
Assessing Infection Risks in Older Adults with Diabetes
Editor: Your research highlights the importance of glycemic control in older adults. How does this factor into infection risk?
Dr. Martinez: For older adults, managing diabetes requires a delicate balance. While tighter glycemic control can reduce long-term complications, it also increases the risk of dangerously low blood sugar, which can be especially harmful for this population. Current guidelines recommend more relaxed glycemic control for older adults, but we wanted to explore whether this approach might increase their risk of infections. Our study focused on the relationship between A1C levels and hospitalization rates for infections.
We divided participants into three A1C ranges: 6-7%, 7-8%, and 8-9%. We then analyzed hospitalization rates for respiratory, genitourinary, skin/soft tissue/bone, and sepsis infections. Interestingly, while higher A1C levels (8-9%) did not significantly increase hospitalizations for most infections, they were associated with a 33% higher risk of skin, soft tissue, and bone infections.
Personalizing Diabetes Care for Older Patients
Editor: What do these findings mean for the way clinicians manage older patients with diabetes?
Dr.Martinez: These findings underscore the importance of individualized care.For many older patients, aggressively lowering blood sugar may not make clinical sense and could introduce unnecessary risks. In my practice, I aim for an A1C range of 7 to 8% for most older adults.Though, for patients at risk of low blood sugar or those undergoing notable life transitions, like moving to a nursing home, the benefits of looser glycemic control may outweigh the risks. It’s about tailoring treatment plans to each patient’s unique needs and circumstances.
Diabetes, Infections, and the Pandemic
Editor: The COVID-19 pandemic has brought attention to the connection between chronic diseases like diabetes and infectious risks. How does diabetes factor into this relationship?
Dr. Martinez: The pandemic has highlighted the interconnectedness of chronic diseases and infection risks. People with diabetes are at higher risk of severe outcomes from infections, including COVID-19. This underscores the need for a deeper understanding of how diabetes impacts the immune system.More research is essential to inform not onyl medication choices but also optimal glycemic control levels for individuals. Such studies could have significant implications for public health, especially in the context of infectious disease challenges.
Key Takeaways for Patients and Caregivers
Editor: What key points would you like patients and caregivers to take away from this research?
Dr. Martinez: First, it’s important to recognize that diabetes increases the risk of infections, particularly skin-related ones. Second, managing diabetes in older adults requires a balanced approach—aiming for a moderate A1C range rather than overly tight control can reduce risks.individualized care is crucial.Patients should work closely with their healthcare providers to develop a treatment plan that considers their unique health circumstances.
Conclusion
As we continue to navigate the complexities of diabetes management, studies like Dr. Martinez’s remind us of the importance of balancing risks and benefits, especially for older adults. Understanding the hidden risks of diabetes is crucial. By staying informed,we can make better decisions for our health and the health of our loved ones.For more insights into diabetes and metabolic health,visit Yale’s Section of Endocrinology and Metabolism.
