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. 2017 May 27;5(1):e000336.
doi: 10.1136/bmjdrc-2016-000336. eCollection 2017.

The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies

Waseem Abu-Ashour  1 , Laurie Twells  1   2 , James Valcour  2 , Amy Randell  1 , Jennifer Donnan  1 , Patricia Howse  2 , John-Michael Gamble  1
Affiliations

The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies

Waseem Abu-Ashour et al. BMJ Open Diabetes Res Care. .

Abstract

Objective: To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis.

Research design and methods: Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2statistic and explored using subgroup analyses.

Results: A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75).

Conclusion: Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.

Keywords: Diabetes; infection; meta-analysis.; observational studies; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Pooled crude (A) and adjusted (B) OR for cohort studies and pooled crude (C) and adjusted (D) OR for case–control studies  by infection type.
See this image and copyright information in PMC

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