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Epidemiology/health services research
Bacterial infections in patients with type 1 diabetes: a 14-year follow-up study
  1. Johan R Simonsen1,2,3,
  2. Valma Harjutsalo1,2,3,4,
  3. Asko Järvinen5,
  4. Juha Kirveskari6,
  5. Carol Forsblom1,2,3,
  6. Per-Henrik Groop1,2,3,7,
  7. Markku Lehto1,2,3,
  8. on behalf of the FinnDiane Study Group
  1. 1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
  2. 2Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
  3. 3Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
  4. 4Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
  5. 5Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
  6. 6Helsinki University Hospital Laboratory, Department of Bacteriology, Helsinki University Central Hospital, Helsinki, Finland
  7. 7Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr Markku Lehto; markku.lehto{at}helsinki.fi

Abstract

Objective This study explored the annual occurrence/incidence of bacterial infections, and their association with chronic hyperglycemia and diabetic nephropathy, in patients with type 1 diabetes.

Design In a register-based follow-up study, we investigated the frequency of bacterial infections in patients with type 1 diabetes (n=4748) and age-matched and sex-matched non-diabetic control (NDC) subjects (n=12 954) using nationwide register data on antibiotic drug prescription purchases and hospital discharge diagnoses, collected between 1996 and 2009. Diabetic nephropathy was classified based on the urinary albumin excretion rate (AER).

Results The hospitalization rate due to bacterial infections was higher in patients with diabetes compared with NDCs (rate ratio (RR) 2.30 (95% CI 2.11 to 2.51)). The rate correlated with the severity of diabetic nephropathy: RR for microalbuminuria was 1.23 (0.94 to 1.60), 1.97 (1.49 to 2.61) for macroalbuminuria, 11.2 (8.1 to 15.5) for dialysis, and 6.72 (4.92 to 9.18) for kidney transplant as compared to patients with diabetes and normal AER. The annual number of antibiotic purchases was higher in patients with diabetes (1.00 (1.00 to 1.01)) as compared with NDCs (0.47 (0.46 to 0.47)), RR=1.71 (1.65 to 1.77). Annual antibiotic purchases were 1.18-fold more frequent in patients with microalbuminuria, 1.29-fold with macroalbuminuria, 2.43-fold with dialysis, and 2.74-fold with kidney transplant as compared to patients with normal AER. Each unit of increase in glycated hemoglobin was associated with a 6–10% increase in the number of annual antibiotic purchases.

Conclusions The incidence of bacterial infections was significantly higher in patients with type 1 diabetes compared with age-matched and sex-matched NDC subjects, and correlated with the severity of diabetic nephropathy in inpatient and outpatient settings.

  • Infectious Disease
  • Nephropathy
  • Glycemic Control

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2014-000067

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