When most people think about diabetes complications, they usually think about heart attacks, strokes, vision loss, or kidney disease.
These conditions have received enormous attention from doctors and researchers because they are common and can be life-threatening. A major new study now suggests that another serious danger deserves a place on that list: infections.
According to researchers from City St George’s, University of London, infections may be causing far more illness and death among people with diabetes than many healthcare professionals realize. Their findings were published in the journal Diabetes and presented at a major international diabetes conference in the United States.
The study examined health records from more than 800,000 people living with type 1 diabetes, type 2 diabetes, or prediabetes in England. Researchers compared their health outcomes with more than one million people who did not have diabetes.
By linking family doctor records, hospital data, and mortality records, the team was able to build one of the most comprehensive pictures ever of infection risk in people with abnormal blood sugar levels.
The findings were striking. Across every category studied, people with diabetes experienced substantially more infections than those without diabetes. The increased risk was not limited to severe infections requiring hospitalization. It was also seen in infections diagnosed and treated in community healthcare settings.
People with type 1 diabetes faced the highest risks. They were much more likely to develop infections and were more than three times as likely to require hospitalization because of infection. Type 2 diabetes was also associated with significantly increased risks, while even prediabetes carried a measurable increase in infection-related illness.
Prediabetes is often viewed as a warning stage before full diabetes develops. Millions of people have prediabetes without knowing it because symptoms are often absent. The new findings suggest that health risks may begin earlier than previously recognized, even before diabetes is formally diagnosed.
One particularly important finding involved mortality. Researchers discovered that infection ranked as the third most common underlying cause of death among people with type 2 diabetes. Only cardiovascular disease and cancer caused more deaths. This places infection among the most significant threats facing people with diabetes.
The study also identified the types of infections causing the greatest harm. Lung infections, including pneumonia, were the most common infections leading to hospitalization. Severe bloodstream infections and respiratory infections were major contributors to infection-related deaths.
Scientists have several theories about why diabetes increases infection risk. High blood sugar may impair the immune system’s ability to fight invading germs.
Diabetes can also affect blood circulation, making it harder for immune cells to reach infected tissues. In addition, some people with diabetes may have other health conditions that increase vulnerability.
The researchers found that blood sugar control plays an important role. In type 1 diabetes, infection risk increased as blood sugar levels rose. In type 2 diabetes, however, large swings in blood sugar appeared especially important. This means that stable blood sugar control may be just as important as achieving a good average reading.
These findings have practical implications for patient care. The researchers argue that healthcare providers should place greater emphasis on infection prevention. This could include earlier treatment of suspected infections, better patient education, stronger vaccination programs, and closer monitoring of blood sugar control.
They also suggest that healthcare systems may need to prioritize people with diabetes when evaluating possible infections. Earlier diagnosis and treatment could potentially prevent many hospital admissions and reduce deaths.
One reason the findings are attracting attention is the enormous number of people affected. Diabetes rates continue to rise globally, driven by aging populations, obesity, and lifestyle factors. As the number of people living with diabetes grows, infection-related complications may become an even greater public health challenge.
The study’s strengths include its very large sample size and the use of linked medical records covering multiple healthcare settings. This allowed researchers to capture both mild and severe infections. Because the study followed people over several years, it also provided valuable information about long-term risks.
Study analysis: This research makes a compelling case that infection should be considered a core complication of diabetes. The fact that infection was the third leading cause of death among people with type 2 diabetes highlights the scale of the problem.
Although the study cannot prove a direct cause-and-effect relationship, the consistent increases in infection risk across diabetes and prediabetes groups provide strong evidence that infection prevention deserves a larger role in diabetes management. The findings could influence future clinical guidelines and improve outcomes for millions of people worldwide.
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Source: City St George’s, University of London.
