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Epidemiology/Health Services Research
The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies
  1. Waseem Abu-Ashour1,
  2. Laurie Twells1,2,
  3. James Valcour2,
  4. Amy Randell1,
  5. Jennifer Donnan1,
  6. Patricia Howse2,
  7. John-Michael Gamble1
  1. 1 School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
  2. 2 Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
  1. Correspondence to Dr John-Michael Gamble; jgamble{at}mun.ca

Abstract

Objective To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis.

Research design and methods Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case–control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2statistic and explored using subgroup analyses.

Results A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75).

Conclusion Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.

  • Diabetes
  • infection
  • observational studies
  • systematic review
  • meta-analysis.

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-2016-000336

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    Footnotes

    • Contributor WAA, LT, JV, and JMG were involved in the concept and design of the study. AR, JD, and PH were secondary reviewers who screened and verified data extraction. WAA was responsible for the data analysis and drafting the first version of the manuscript. All authors contributed to the interpretation of data and provided revisions to the manuscript. WAA will act as guarantor for the study.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Appendix C under supplementary information contains data for individual studies included in our review.