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

Waseem Abu-Ashour; Laurie Twells; James Valcour; Amy Randell; Jennifer Donnan; Patricia Howse; John-Michael Gamble

doi:10.1136/bmjdrc-2016-000336

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

BMJ Open Diabetes Res Care. 2017 May 27;5(1):e000336. doi: 10.1136/bmjdrc-2016-000336. eCollection 2017.

Authors

Waseem Abu-Ashour¹, Laurie Twells^{1

2}, James Valcour², Amy Randell¹, Jennifer Donnan¹, Patricia Howse², John-Michael Gamble¹

Affiliations

¹ School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
² Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.

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.