Elevated risk of infection in individuals with hyperinsulinaemic type 2 diabetes: a Danish 12 year cohort study

IF 8.4 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetologia Pub Date : 2024-12-11 DOI:10.1007/s00125-024-06342-x

Frederik P. B. Kristensen, Sidsel L. Domazet, Jens S. Nielsen, Jacob V. Stidsen, Kurt Højlund, Henning Beck-Nielsen, Peter Vestergaard, Niels Jessen, Michael H. Olsen, Torben Hansen, Charlotte Brøns, Allan Vaag, Henrik T. Sørensen, Reimar W. Thomsen

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Abstract

Aims/hypothesis

A better understanding of the mechanisms underlying an elevated infection risk in individuals with type 2 diabetes is needed to guide risk stratification and prevention. We investigated the risk of infection in subgroups of individuals with type 2 diabetes according to indices of insulin sensitivity and beta cell function.

Methods

We classified 7265 individuals with recently diagnosed type 2 diabetes (median duration 1.4 years, IQR 0.5–2.9 years) into hyperinsulinaemic (high beta cell function [HOMA 2-beta-cell function, HOMA2-B], low insulin sensitivity [HOMA 2-insulin sensitivity, HOMA2-S]), classical (low HOMA2-B, low HOMA2-S) and insulinopenic (low HOMA2-B, high HOMA2-S) type 2 diabetes. Individuals were followed until first hospital-treated infection or first prescription for an anti-infective agent (community-treated infection). We used Cox regression analysis to estimate HRs adjusted for age, sex, index year, diabetes duration and treatment, lifestyle behaviours and comorbidities.

Results

Among study participants, 28% had hyperinsulinaemic, 63% had classical and 9% had insulinopenic type 2 diabetes. The 10 year risks of hospital-treated infections were 42.3%, 36.8% and 31.0% in the three subgroups, respectively. Compared with the insulinopenic subgroup, adjusted HRs for hospital-treated infections were elevated for hyperinsulinaemic (1.38 [95% CI 1.16, 1.65]) and classical type 2 diabetes (1.20 [95% CI 1.02, 1.42]). The 10 year risks of community-treated infections were high in all three subgroups at 91.6%, 90.1% and 88.3%, respectively, corresponding to adjusted HRs of 1.20 (95% CI 1.08, 1.33) for the hyperinsulinaemic and 1.10 (95% CI 1.00, 1.21) for the classical subgroup. Infection risk in the hyperinsulinaemic subgroup decreased substantially when further adjusted for abdominal obesity, metabolic derangements and low-grade inflammation.

Conclusions/interpretation

The risk of severe infections is clearly elevated in individuals with type 2 diabetes characterised by a higher degree of insulin resistance/hyperinsulinaemia.

Graphical Abstract

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高胰岛素血症型2型糖尿病患者感染风险升高：一项丹麦12年队列研究

目的/假设需要更好地了解2型糖尿病患者感染风险升高的机制，以指导风险分层和预防。我们根据胰岛素敏感性和β细胞功能指标调查了2型糖尿病个体亚组感染的风险。方法将7265例新近确诊的2型糖尿病患者（中位病程1.4年，IQR 0.5 ~ 2.9年）分为高胰岛素血症（高β细胞功能[HOMA 2- β细胞功能，HOMA2-B]，低胰岛素敏感性[HOMA 2-胰岛素敏感性，HOMA2-S]），典型（低HOMA2-B，低HOMA2-S）和胰岛素缺乏（低HOMA2-B，高HOMA2-S） 2型糖尿病。随访个体直至首次住院治疗感染或首次使用抗感染药物（社区治疗感染）。我们使用Cox回归分析来估计经年龄、性别、指标年份、糖尿病病程和治疗、生活方式行为和合并症调整后的hr。结果在研究参与者中，28%患有高胰岛素血症，63%患有典型2型糖尿病，9%患有胰岛素缺乏型糖尿病。在三个亚组中，住院治疗感染的10年风险分别为42.3%、36.8%和31.0%。与胰岛素缺乏亚组相比，高胰岛素血症（1.38 [95% CI 1.16, 1.65]）和典型2型糖尿病（1.20 [95% CI 1.02, 1.42]）住院治疗感染的调整hr升高。在所有三个亚组中，社区治疗感染的10年风险都很高，分别为91.6%、90.1%和88.3%，对应于高胰岛素血症亚组的调整hr为1.20 (95% CI 1.08, 1.33)，经典亚组的调整hr为1.10 （95% CI 1.00, 1.21）。当进一步调整腹部肥胖、代谢紊乱和低度炎症时，高胰岛素血症亚组的感染风险显著降低。结论/解释以较高程度的胰岛素抵抗/高胰岛素血症为特征的2型糖尿病患者严重感染的风险明显升高。图形抽象

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来源期刊

Diabetologia 医学-内分泌学与代谢

CiteScore

18.10

自引率

2.40%

发文量

193

审稿时长

1 months

期刊介绍： Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.