Type 2 diabetes is well-known for its link to a range of serious health complications, including heart disease, nerve damage, kidney failure, and eye issues. However, a lesser-discussed aspect of the condition is its connection to increased vulnerability to infections, especially among older adults. Dr. Kasia Lipska, an associate professor of medicine at Yale School of Medicine, has recently highlighted the significant role infections play in hospitalizations for individuals with type 2 diabetes, particularly the elderly.
In a recent interview, Dr. Lipska, whose research focuses on the risks of infections in people with type 2 diabetes, provided valuable insights into how diabetes affects the immune system and how blood sugar control impacts infection risk.
The Impact of Type 2 Diabetes on Immunity
“Diabetes influences the immune system in several ways,” explained Dr. Lipska. “Chronic high blood sugar weakens the function of white blood cells, which are crucial for fighting infections.” This impairment makes it more difficult for individuals with type 2 diabetes to ward off infections. Additionally, complications such as peripheral neuropathy and poor circulation further increase infection risk, particularly in the extremities. “When high blood sugar is combined with impaired blood flow, healing becomes more challenging, which can lead to more frequent infections,” Dr. Lipska added.
Research Findings: The Connection Between Glycemic Control and Infection Risk
In her recent study, Dr. Lipska and her team sought to explore the relationship between glycemic control and infection risk in older adults with type 2 diabetes. The current guidelines for elderly patients recommend less stringent blood sugar control compared to younger adults, due to the higher risk of hypoglycemia (low blood sugar) in the older population. However, the question remained: Does allowing higher blood sugar levels increase the risk of infections in these individuals?
The study divided patients’ glycemic control into three ranges: A1C levels between 6 to 7 percent, 7 to 8 percent, and 8 to 9 percent. The researchers then analyzed the association between these levels and hospitalizations related to four types of infections: respiratory, genitourinary, skin/soft tissue/bone, and sepsis.
Dr. Lipska’s team found that, for the most part, having an A1C on the higher end of the recommended range did not significantly increase the risk of hospitalization for these infections. However, individuals with an A1C between 8 and 9 percent did face a 33% higher risk of developing skin, soft tissue, and bone infections compared to those with lower A1C levels.
Implications for Older Adults with Type 2 Diabetes
These findings offer important clinical insights. Dr. Lipska emphasized that, for older patients where strict blood sugar control may not be feasible or beneficial, aiming for an A1C of 7 to 8 percent is generally a reasonable target. “In patients who are at risk of hypoglycemic episodes or undergoing significant life changes, such as transitioning to a nursing home, slightly higher blood sugar levels may be more beneficial,” she explained. In such cases, the small increase in infection risk may be outweighed by the benefits of avoiding dangerous low blood sugar events.
As the ongoing COVID-19 pandemic has underscored, chronic conditions like diabetes are closely linked with an elevated risk of severe infections. Given these findings, Dr. Lipska advocates for further research to better understand the complex relationship between diabetes, infection risks, and optimal glycemic control strategies. “We need more studies to refine how we manage diabetes in relation to infection risks and to help us tailor treatments that consider the individual health needs of each patient,” she concluded.
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