As Diabetes Patients Face Heightened Infection Risk, Study Calls For Urgent Guideline Overhaul

If you have diabetes, your risk of developing infections may be higher than in the general population. This clinical warning is increasingly being supported by large-scale evidence, with a new study highlighting a consistently elevated infection burden across the entire diabetes spectrum.

It has called for infections to be formally integrated into clinical diabetes guidelines, which at present just prioritise glycaemic control, cardiovascular risk reduction and kidney protection.

The study, published in the latest edition of Diabetes, found that people with type 1 diabetes face an 81% higher risk of infections managed in primary care and more than three times higher risk of hospitalisation due to infections. Those with type 2 diabetes show a 51% higher risk of primary care infections and a 91% higher risk of hospital admission. Even individuals with prediabetes are not spared, with a 35% increased risk of infection compared to the non-diabetic population.

Alarmingly, infections have emerged as the third most common underlying cause of death in type 2 diabetes, after cardiovascular disease and cancer. Lower respiratory tract infections, such as pneumonia, account for the highest proportion of hospital admissions, while sepsis and respiratory infections remain the leading causes of infection-related deaths.

Taken together, these findings highlight a critical but under-recognised aspect of diabetes care: the disease does not only affect glucose metabolism but also significantly compromises the body’s immune defences.

As a result, infections are emerging as a major, yet insufficiently addressed, contributor to illness, hospitalisation and mortality among people living with diabetes.

The findings were presented at the American Diabetes Association Scientific Sessions in New Orleans. Researchers analysed anonymised general practitioner records linked with hospital admissions and mortality data from England, covering more than 800,000 individuals with type 1 diabetes, type 2 diabetes and prediabetes, alongside over one million matched controls, followed over five years.

At present, most treatment frameworks prioritise glycaemic control, cardiovascular risk reduction and kidney protection, while infection prevention and early recognition receive comparatively limited attention.

Professor Julia Critchley of City St George’s, University of London, who led the study, described infections in diabetes as “common, serious and often preventable”, noting that they remain largely absent from routine clinical protocols. She stressed that, with the global diabetes burden rising sharply, infection risk must be treated as a core component of care rather than an afterthought.

The study also draws attention to an important metabolic insight: glycaemic variability appears to play a crucial role in infection susceptibility. In type 1 diabetes, higher blood glucose levels were directly associated with increased infection risk.

In type 2 diabetes, however, fluctuations in glucose levels over time—rather than average values alone—were linked to severe infections requiring hospitalisation. This suggests that patients who appear reasonably controlled in routine testing may still face elevated risk if their blood sugar levels vary significantly.

Clinically, these findings strengthen the case for proactive infection monitoring in diabetes care. Respiratory infections, particularly pneumonia, were the leading cause of hospitalisation, while sepsis and respiratory infections accounted for most infection-related deaths.

Experts emphasise that early detection systems, vaccination strategies and rapid response protocols could substantially reduce avoidable complications.

The implications are particularly significant for India, which carries one of the world’s largest diabetes burdens.

Public health experts note that delayed diagnosis, uneven access to primary care, overcrowded health facilities and interruptions in treatment may further increase vulnerability to infections. Tuberculosis, urinary tract infections (UTI) and skin infections already represent a substantial burden among diabetic patients in the country.

Clinicians argue that diabetes management in India must move beyond a purely glucose-centric approach. Strengthening infection screening, improving immunisation coverage, ensuring timely antimicrobial treatment and increasing patient awareness of early warning signs are being viewed as essential components of comprehensive care.

Experts also highlighted the importance of lifestyle interventions, including improved nutrition, weight management and physical activity, alongside better monitoring of blood glucose variability rather than relying solely on periodic HbA1c tests.