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Diabetes Increases Risk for Pneumonia-Related Hospitalization

Posted: Friday, August 08, 2008

Type 1 and type 2 diabetes are linked with an increased risk for pneumonia-related hospitalization, and poor glycemic control increases this risk, according to the results of a population-based, case-control study. 
In the past decade, hospitalizations for pneumonia have risen 20% to 50% in Western populations, and combined with influenza, pneumonia is the seventh leading cause of death in the United States. Five cohort studies showed that diabetes is a risk factor for pneumonia, whereas 3 studies showed no association.

Because studies to date have had limitations, the effect of poor long-term glycemic control on the risk for pneumonia-related hospitalization is still unclear. In light of the increasing incidence of pneumonia-related hospitalizations and diabetes, it is important to elucidate the relationship between diabetes or poor long-term glycemic control and the risk for pneumonia.

"Diabetes is thought to be a risk factor for pneumonia, but available data are few and inconclusive," write Jette B. Kornum, MD, from Aarhus University Hospital in Aalborg, Denmark, and colleagues. "Diabetic subjects may have increased susceptibility to pneumonia for several reasons. They are at increased risk of aspiration, hyperglycemia, decreased immunity, impaired lung function, pulmonary microangiopathy, and coexisting morbidity."

The goals of this study were to determine whether diabetes is a risk factor for hospitalization with pneumonia and to evaluate the effect of hemoglobin A1c level on this risk.

Using healthcare databases in northern Denmark, the investigators identified patients with a first-time pneumonia-related hospitalization between 1997 and 2005 (case patients; n = 34,239), and they selected 10 sex-matched and age-matched population control subjects for each case patient (n = 342,390) from Denmark's Civil Registration System. Relative risk (RR) for pneumonia-related hospitalization among participants with and without diabetes was calculated with conditional logistic regression, after adjustment for potential confounding factors.

Compared with participants without diabetes, those with diabetes had an adjusted RR for pneumonia-related hospitalization of 1.26 (95% confidence interval [CI], 1.21 - 1.31). For participants with type 1 diabetes, adjusted RR was 4.43 (95% CI, 3.40 - 5.77) vs 1.23 (95% CI, 1.19 - 1.28) for those with type 2 diabetes.

Diabetes duration of 10 years or more was associated with an increased risk for pneumonia-related hospitalization (RR, 1.37; 95% CI, 1.28 - 1.47). Adjusted RR was 1.22 (95% CI, 1.14 -1.30) for diabetic participants with a hemoglobin A1c level of less than 7%, and it was 1.60 (95% CI, 1.44 - 1.76) for diabetic participants with a hemoglobin A1c level of 9% or more vs participants without diabetes.

"Type 1 and type 2 diabetes are risk factors for a pneumonia-related hospitalization," the study authors write. "Poor long-term glycemic control among patients with diabetes clearly increases the risk of hospitalization with pneumonia."

"Our data, combined with previous results, provide strong evidence that diabetes is associated with a 25�75% increase in the RR of pneumonia-related hospitalization," the study authors conclude. "Longer duration of diabetes and poor glycemic control increase the risk of pneumonia-related hospitalization. These results emphasize the value of influenza and pneumococcal immunization, particularly for patients with longer diabetes duration, and the importance of improved glycemic control to prevent pneumonia-related hospitalization among diabetic patients."

Practice Pearls:

  • Type 1 diabetes was associated with a more than 4-fold increased risk for a pneumonia-related hospitalization, and type 2 diabetes was associated with a 1.2-fold increased risk.
  • The relative effect of diabetes was greatest in younger adults and in participants without coexisting morbidity.
  • Poor long-term glycemic control and longer diabetes duration increased the risk for pneumonia-related hospitalization.The investigators highlight the value of influenza and pneumococcal immunizations, particularly for patients with longer duration of diabetes as well as the value of better glycemic control, to prevent pneumonia-related hospitalization. 

Source: Diabetes In Control: Diabetes Care. 2008;31:1541-1545.

 
 
 
 
 
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