For many years, doctors have focused on heart disease, stroke, kidney failure, and nerve damage as some of the most important complications of diabetes.
However, a major new study suggests there is another serious health risk that deserves far more attention: infections.
The research was published in the journal Diabetes and presented at the American Diabetes Association Scientific Sessions in New Orleans.
The findings come from one of the largest studies ever conducted on diabetes and infection risk. Researchers found that people living with type 1 diabetes, type 2 diabetes, and even prediabetes face a much higher risk of developing infections than people without these conditions.
Diabetes is one of the fastest-growing health problems in the world. Hundreds of millions of people live with the condition, and many more have prediabetes, a state in which blood sugar levels are higher than normal but not yet high enough for a diabetes diagnosis.
Doctors have long known that high blood sugar can weaken the body’s ability to fight infections. However, the full scale of the problem has often been overlooked.
To better understand the issue, researchers from City St George’s, University of London analyzed medical records from more than 800,000 people in England who had type 1 diabetes, type 2 diabetes, or prediabetes.
They compared these individuals with more than one million people of similar age, sex, and ethnicity who did not have diabetes. The participants were followed for five years.
The results showed that infection risk increased across the entire diabetes spectrum. People with type 1 diabetes faced the greatest risk. Compared with people without diabetes, they were 81% more likely to develop infections treated by their family doctor and more than three times as likely to be hospitalized because of an infection.
People with type 2 diabetes also faced substantial risks. They had a 51% higher chance of developing infections treated in primary care and a 91% higher risk of hospitalization due to infection. Even people with prediabetes were affected. Their risk of infection treated by a doctor was 35% higher, while their risk of infection-related hospitalization was 33% higher.
One of the most surprising findings was the role infections play in deaths among people with diabetes. For people with type 2 diabetes, infection was the third most common underlying cause of death, ranking behind cardiovascular disease and cancer. This suggests that infections are not simply a minor complication but a major health threat.
The study found that lower respiratory tract infections, including pneumonia, were the most common infections requiring hospitalization in people with type 1 and type 2 diabetes.
Researchers also found that sepsis, a life-threatening reaction to infection, and lower respiratory infections were among the leading causes of infection-related death in people with type 2 diabetes.
The researchers explored why people with diabetes may be more vulnerable. One important factor appears to be blood sugar control. In type 1 diabetes, higher blood sugar levels were linked to a greater risk of infection.
In type 2 diabetes, large fluctuations in blood sugar over time appeared to be particularly important. Even people whose average blood sugar levels seemed acceptable could face higher infection risks if their readings varied greatly between medical visits.
These findings suggest that doctors may need to pay more attention not only to average blood sugar levels but also to how stable those levels remain over time.
The researchers believe current diabetes guidelines do not adequately address infection risk. Most guidelines focus heavily on preventing heart disease, kidney disease, and other well-known complications. While these remain extremely important, the authors argue that infection prevention should become a core part of diabetes care.
They recommend stronger efforts to educate patients about infection symptoms, encourage early medical attention, improve blood sugar management, and prioritize people with diabetes for rapid assessment when infections are suspected.
The study has several strengths. It included a very large number of participants and used real-world medical records linked to hospital and death data. This allowed researchers to examine infection risks across a broad population.
However, like all observational studies, it cannot prove that diabetes directly caused every infection. Other factors may also contribute. Even so, the size of the study and the consistency of the findings make the results highly convincing.
Study analysis: The research provides strong evidence that infections should be viewed as a major complication of diabetes rather than a secondary concern. The findings highlight the importance of infection prevention, early treatment, and stable blood sugar control.
While more research is needed to understand the biological mechanisms involved, the study clearly shows that infections contribute substantially to illness, hospitalization, and death among people with diabetes and prediabetes. These findings could lead to important changes in diabetes care guidelines around the world.
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Source: City St George’s, University of London.
