Journal: BMC medicine
This prospective cohort study examined which factors most strongly predict infections in adults with type 2 diabetes, and how much each contributes to overall infection burden.
Using data from 24,021 individuals with type 2 diabetes followed for a median of 13.2 years, there were 9,988 infection events in 6,517 participants (incidence 33.5 per 1,000 person‑years). Twenty-eight candidate risk factors were grouped into six domains: socioeconomic status, lifestyle, environmental pollution, psychological factors, clinical biomarkers, and comorbidities/diabetes complications.
Nineteen factors were significantly associated with higher infection risk. These included:
- Socioeconomic: higher deprivation, lower education, lower income, retired/unemployed status
- Lifestyle: central obesity (largest individual contributor), unhealthy diet, current smoking, non‑moderate alcohol intake, unhealthy sleep duration
- Psychological: depression, loneliness
- Clinical/biomarker: higher HbA1c, lower HDL‑cholesterol, reduced eGFR
- Comorbidities/complications: cancer, cardiovascular disease, peripheral artery disease, diabetic microvascular complications, and COPD
Central obesity had the highest individual population attributable fraction (PAF 13.2%). By domain, lifestyle factors jointly accounted for the greatest proportion of infections (PAF 32.7%), followed by socioeconomic status (26.3%), comorbidities and complications (25.2%), clinical biomarkers (17.1%), psychological factors (6.3%), and environmental pollution (3.3%).
The authors conclude that infection risk in people with type 2 diabetes is driven by a broad constellation of modifiable and non-modifiable factors, underscoring the need for multifaceted management—particularly targeting lifestyle and metabolic health—rather than focusing solely on glycemic control.