Disease concurrence in diabetes mellitus: a study of concurrent morbidity over 12 months using diabetes mellitus as an example

Virus Infections and Host Metabolism-Can We Manage the Interactions?

When viruses infect cells, they almost invariably cause metabolic changes in the infected cell as well as in several host cell types that react to the infection. Such metabolic changes provide potential targets for therapeutic approaches that could reduce the impact of infection. Several examples are discussed in this review, which include effects on energy metabolism, glutaminolysis and fatty acid metabolism. The response of the immune system also involves metabolic changes and manipulating these may change the outcome of infection. This could include changing the status of herpesviruses infections from productive to latency. The consequences of viral infections which include coronavirus disease 2019 (COVID-19), may also differ in patients with metabolic problems, such as diabetes mellitus (DM), obesity, and endocrine diseases. Nutrition status may also affect the pattern of events following viral infection and examples that impact on the pattern of human and experimental animal viral diseases and the mechanisms involved are discussed. Finally, we discuss the so far few published reports that have manipulated metabolic events in-vivo to change the outcome of virus infection. The topic is expected to expand in relevance as an approach used alone or in combination with other therapies to shape the nature of virus induced diseases.

Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies

Diabetes mellitus is associated with various types of infections notably skin, mucous membrane, soft tissue, urinary tract, respiratory tract and surgical and/or hospital-associated infections. The reason behind this frequent association with infections is an immunocompromised state of diabetic patient because uncontrolled hyperglycemia impairs overall immunity of diabetic patient via involvement of various mechanistic pathways that lead to the diabetic patient as immunocompromised. There are specific microbes that are associated with each type of infection and their presence indicates specific type of infections. For instance, E. coli and Klebsiella are the most common causative pathogens responsible for the development of urinary tract infections. Diabetic-foot infections commonly occur in diabetic patients. In this article, we have mainly focused on the association of diabetes mellitus with various types of bacterial infections and the pattern of resistance against antimicrobial agents that are frequently used for the treatment of diabetes-associated infections. Moreover, we have also summarized the possible treatment strategies against diabetes-associated infections.

Association between diabetes and increased prevalence of paranasal sinus disease: a cross-sectional study in Japanese adults

BACKGROUND

The association between diabetes and paranasal sinus disease has not been thoroughly investigated.

METHODS

We cross-sectionally investigated the association between diabetes and the presence of paranasal sinus disease, which was confirmed by a head MRI scan in 1350 adults who underwent a health screening program focusing on brain diseases and metabolic syndrome. Logistic regression, which was adjusted for age, sex, body mass index, waist-to-hip ratio, hypertension, smoking status, alcohol intake, and white blood cell count, was performed to calculate the odds ratio (OR) of having paranasal sinus disease among adults with diabetes in relation to those without. The dose-response relationship between hemoglobin A1c (HbA1c) levels and the presence of paranasal sinus disease was also investigated.

RESULTS

Of the 1350 participants (mean age, 61.6 ± 10.0 years; 71.6% men), 220 diabetes cases were identified. Paranasal sinus disease was diagnosed in 151 adults. The adjusted OR of having paranasal sinus disease was 1.74 (95% confidence interval [CI], 1.12-2.71) in those with diabetes. The odds of having paranasal sinus disease increased with HbA1c levels. Compared to those with HbA1c of ≤5.4%, those with HbA1c of 5.5%-6.4%, 6.5%-7.9%, and ≥8.0% were more likely to have paranasal sinus disease, with adjusted ORs of 1.32 (95% CI, 0.88-1.98), 1.63 (95% CI, 0.86-3.09) and 2.71 (95% CI, 1.12-6.61), respectively (P for trend = 0.019).

CONCLUSIONS

Diabetes may be significantly associated with higher prevalence of paranasal sinus disease in Japanese adults. We should keep this increased risk in mind when a diabetic patient is suspected of having paranasal sinus disease.

Type 2 diabetes impairs pulmonary function in morbidly obese women: a case-control study

AIMS/HYPOTHESIS

To determine whether the presence of type 2 diabetes and the degree of metabolic control are related to reduced pulmonary function in obese individuals.

METHODS

Seventy-five morbidly obese women (25 with type 2 diabetes [cases]--and 50 without diabetes [controls]) with a history of non-smoking and without prior cardiovascular or respiratory disease were prospective recruited for a case-control study in the outpatient obesity unit of a referral centre. Both groups were closely matched by age, BMI and waist circumference. Pulmonary function test included forced spirometry and static pulmonary volume measurements.

RESULTS

Type 2 diabetic patients showed lower forced expiratory volume at 1 s (FEV1) (mean difference -11.6% of predicted [95% CI -20.4 to -2.8]; p = 0.011), and FEV1/forced vital capacity (FEV1/FVC) ratio (mean difference -4.4% [95% CI -8.1 to -0.7]; p = 0.049), but a greater residual volume (RV) (mean difference 19.5% of predicted [95% CI 10.8-28.3]; p < 0.001). In addition, an obstructive ventilatory pattern was more frequent in diabetic patients. Significant negative correlations between FEV1 and fasting glucose, HbA1c and HOMA insulin resistance (HOMA-IR) were detected. By contrast, RV was positively correlated with fasting glucose, HbA1c and HOMA-IR. Multiple linear regression analyses showed that fasting glucose and HbA1c independently predicted FEV1 and RV.

CONCLUSIONS/INTERPRETATION

The presence of diabetes and the degree of glycaemic control are related to respiratory function impairment in morbidly obese women. Therefore, the impact of type 2 diabetes on pulmonary function should be taken into consideration by those providing care for obese people.

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo-responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community- and hospital-acquired infections.

Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification

OBJECTIVE

To test the hypothesis that disease pathology, psychologic distress, and somatic symptom amplification separately influence health care use by investigating the patterns of comorbidity in patients with diabetes, anxiety, and upper respiratory tract infection (URTI), respectively.

METHODS

Adult diabetes (n=4,365), anxiety (13,421), and URTI (9,854) cases, and 15,000 randomly selected controls were identified from a 1-year national survey of general practice consultations. Comorbidity was based on a standard clinical morbidity classification used by general practitioners in actual consultations.

RESULTS

In case-control analyses of 122 morbidities, the number of significant comorbid associations (P<.01) for diabetes was 30, anxiety was 72, and URTI was 49. These associations showed significant heterogeneity in the odds ratios estimated using Cochran's Q and I2 statistic, both between case groups and within each case group. Diabetes associations were stronger with peripheral vascular disease (odds ratio 2.7), candidiasis (2.5), cataract (2.4), obesity (2.2), and hypertension (1.7); anxiety with depressive disorder (4.1), affective psychosis (4.0), adjustment reaction (3.2), functional gastrointestinal disorders (2.5) and general symptoms (2.5); and URTI with nonspecific blood findings (5.5), bronchitis (5.2), and injury (3.5).

CONCLUSION

Our study shows patterns of clinical comorbidity specific to the case conditions that supports the hypothesis that different mechanisms (disease pathology, psychologic distress, and somatic symptom amplification) operate to influence consultation behavior and comorbidity.

Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study

OBJECTIVE

To examine prospectively the relationship between diabetes, glycemic control, and spirometric measures.

RESEARCH DESIGN AND METHODS

From a community-based cohort, 495 Europid (i.e., of European descent) patients with type 2 diabetes who had no history of pulmonary disease underwent baseline spirometry between 1993 and 1994. A subset of 125 patients was restudied a mean of 7.0 years later. The main outcome measures included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), vital capacity (VC), and peak expiratory flow (PEF) corrected for body temperature, air pressure, and water saturation and were expressed either in absolute terms or as percentage-predicted value for age, sex, and height.

RESULTS

Mean percentage-predicted values of each spirometric measure were decreased >10% in the whole cohort at baseline and absolute measures continued to decline at an annual rate of 68, 71, and 84 ml/year and 17 l/min for FVC, FEV1, VC, and PEF, respectively, in the 125 prospectively studied patients. Declining lung function measures were consistently predicted by poor glycemic control in the form of a higher updated mean HbA1c, follow-up HbA1c, or follow-up fasting plasma glucose. In a Cox proportional hazards model, decreased FEV1 percentage-predicted value was an independent predictor of all-cause mortality.

CONCLUSIONS

Reduced lung volumes and airflow limitation are likely to be chronic complications of type 2 diabetes, the severity of which relates to glycemic exposure. Airflow limitation is a predictor of death in type 2 diabetes after adjusting for other recognized risk factors.

Infections in patients with type 2 diabetes in general practice

BACKGROUND

The association between diabetes, glycaemic control and the prevalence of infections seems obvious to most general practitioners. However, this association is still not very clear.

AIM

The aim of this study in general practice was to investigate which infections patients with treated type 2 diabetes present to their general practitioner, and to study whether a relationship exists between glycaemic status and these infections.

METHOD

Over a period of 2 years eight fasting glucose and glycosylated haemoglobin values were related to the presented infections in 328 patients.

RESULTS

193 patients presented with one or more infections (a total of 458 infections, with a mean of 2.4 (+/- 1.9) infections). Patients with and without infections did not differ in mean glycosylated haemoglobin and fasting glucose levels. There was no difference in presentation of infections between well controlled and less controlled patients. However, patients who presented with an infection showed significantly higher mean glycosylated haemoglobin levels in that period compared to the mean levels in periods without any infection.

CONCLUSION

Considering the limitations of this study, hyperglycaemia is more likely a result of than a cause of common infections.