SPECTRUM AND OUTCOMES OF OPPORTUNISTIC INFECTIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A HOSPITAL-BASED OBSERVATIONAL STUDY IN NORTH KARNATAKA

SIDDAGANGA SANGAVI; RACHANA Y HEBBAL; VRUSHALI MOHITE; VIJAYALAKSHMI KP

doi:10.22159/ajpcr.2025v18i9.55056

Authors

SIDDAGANGA SANGAVI Department of General Medicine, KLE JGMM Medical College, Hubballi, Karnataka, India. https://orcid.org/0000-0003-1614-6912
RACHANA Y HEBBAL KLE JGMM Medical College, Hubballi, Karnataka, India.
VRUSHALI MOHITE Department of General Medicine, KLE JGMM Medical College, Hubballi, Karnataka, India
VIJAYALAKSHMI KP Department of General Medicine, KLE JGMM Medical College, Hubballi, Karnataka, India https://orcid.org/0000-0001-5550-0959

DOI:

https://doi.org/10.22159/ajpcr.2025v18i9.55056

Keywords:

Type 2 Diabetes Mellitus (T2DM), Opportunistic Infections, HbA1c, Urinary Tract Infection, Pneumonia, Glycemic Control, Hospital Outcomes, Comorbidities;

Abstract

Objective: Patients with type 2 diabetes mellitus (T2DM) are at increased risk for opportunistic infections due to impaired immune responses and chronic hyperglycemia. This study aimed to assess the spectrum, burden, and clinical outcomes of opportunistic infections in T2DM patients at a tertiary care hospital.

Methods: A hospital-based observational study was conducted from August 2024 to January 2025, involving 141 T2DM patients with infections out of a total of 440 diabetic patients who attended inpatient and outpatient services. Demographic data, infection types, glycemic control (glycosylated hemoglobin [HbA1c]), comorbidities, treatment modalities, and outcomes were analyzed. Chi-square testing was used to assess associations between infection types and sex.

Results: The prevalence of infections among T2DM patients was 32.04%. The majority were aged 51–60 years (70.2%), and males were slightly more affected (53.2%). Most infections occurred in patients with a diabetes duration of 6–10 years and HbA1c levels between 9 and 11%. Acute gastroenteritis (21.3%), urinary tract infections (34%), and pneumonia (10.6%) were the most common. Pneumonia showed a significant association with male sex (p=0.026). Hypertension was the most frequent comorbidity (90.7%). Overall, 89.7% of patients recovered, whereas 10.3% developed complications; no mortality was recorded. Longer hospital stays were significantly associated with poor glycemic control (HbA1c >8.5%, p=0.03).

Conclusion: Opportunistic infections are common in T2DM, especially among patients with longer disease duration and poor glycemic control. Early recognition and optimized diabetes management are essential for reducing infection-related complications and hospitalization.

Downloads

Download data is not yet available.

References

1. Atkins RC, Zimmet P. Diabetic kidney disease: Act now or pay later. Saudi J Kidney Dis Transpl. 2010;21(2):217-21. doi: 10.1093/ndt/ gfp757, PMID 20228503

2. Sarkar S, Sadhu S, Roy R, Tarafdar S, Mukherjee N, Sil M, et al. Contemporary drifts in diabetes management. Int J Appl Pharm. 2023;15(2):1-9. doi: 10.22159/ijap.2023v15i2.46792

3. Darusman F, Rusdiana T, Sopyan I, Yuliar NF, Aryani R. Bioequivalence of metformin as an oral antidiabetic: A systematic review. Int J Appl Pharm. 2023;15(6):76-81. doi: 10.22159/ijap.2023v15i6.49142

4. Rao PS, Batool S, Maniyar SA, Tunnisa F, Ali Sohail M, Ali MM, et al. A community-based survey to assess the prevalence and etiological factors for type II diabetes mellitus in the two regional states of Southern India-a pilot study. Int J Pharm Pharm Sci. 2024;16(3):31-8. doi: 10.22159/ijpps.2024v16i3.50297

5. Narwat A, Goyal A, Bhati R. A systematic review on adherence to oral antidiabetic drugs in patients with type 2 diabetes mellitus. Int J Curr Pharm Res. 2024;16(6):11-3. doi: 10.22159/ijcpr.2024v16i6.5091

6. Lipsky BA, Tabak YP, Johannes RS, Vo L, Hyde L, Weigelt JA. Skin and soft tissue infections in hospitalised patients with diabetes: Culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia. 2010;53(5):914-23. doi: 10.1007/s00125-010- 1672-5, PMID 20146051

7. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41(3):281-8. doi: 10.1086/431587, PMID 16007521

8. Van Den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449-61. doi: 10.1056/NEJMoa052521, PMID 16452557

9. Sibila O, Restrepo MI, Anzueto A. What is the best antimicrobial treatment for severe community-acquired pneumonia (including the role of steroids and statins and other immunomodulatory agents)? Infect Dis Clin North Am. 2013;27(1):133-47. doi: 10.1016/j.idc.2012.11.014, PMID 23398870

10. Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza- Albarrán AA, et al. Diabetes in developing countries. J Diabetes. 2019;11(7):522-39. doi: 10.1111/1753-0407.12913, PMID 30864190

11. World Health Organization. Global Report on Diabetes. Geneva: World Health Organization; 1999.

12. Cooke FJ. Infections in people with diabetes. Medicine. 2022;50(11):729-32. doi: 10.1016/j.mpmed.2022.08.006

13. Karina D, Heldayani I, Hidayat W. Oral opportunistic infection induced by stress and silent type 2 diabetes mellitus in young adult patient: A case report. Int Med Case Rep J. 2025;18:59-66. doi: 10.2147/ IMCRJ.S488127, PMID 39822734

14. Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: A matched cohort study. Diabetes Care. 2018;41(3):513-21. doi: 10.2337/dc17-2131, PMID 29330152

15. Todd K, Gunter K, Bowen JM, Holmes CL, Tilston-Lunel NL, Vornhagen J. Type-2 Diabetes Mellitus Enhances Klebsiella Pneumonia Pathogenesis. Vol. 5. bioRxiv [Preprint]; 2024. p. 596766. doi: 10.1101/2024.05.31.596766

16. Bettegowda S, Iyengar VS, Gosain V, Naik VG, Vuyyuru S, Bandreddi GK. Clinical profile and spectrum of infections in type 2 diabetes mellitus patients: A retrospective study from rural tertiary care hospital of South Karnataka, India. Hypertension. 2014;160:62-99. doi: 10.36347/sjams.2014.v02i06.094

17. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26(2):510-3. doi: 10.2337/ diacare.26.2.510, PMID 12547890

18. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16 Suppl 1:S27-36. doi: 10.4103/2230-8210.94253, PMID 22701840

19. Gallacher SJ, Thomson G, Fraser WD, Fisher BM, Gemmell CG, MacCuish AC. Neutrophil bactericidal function in diabetes mellitus: Evidence for association with blood glucose control. Diabet Med. 1995;12(10):916-20. doi: 10.1111/j.1464-5491.1995.tb00396.x, PMID 8846684

20. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997;14(1):29-34. doi: 10.1002/(SICI)1096- 9136(199701)14:1<29:AID-DIA300>3.0.CO;2-V, PMID 9017350

21. Valerius NH, Eff C, Hansen NE, Karle H, Nerup J, Søeberg B, et al. Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Med Scand. 1982;211(6):463-7. doi: 10.1111/j.0954-6820.1982. tb01983.x, PMID 6981286

22. Zargar AH, Masoodi SR, Laway BA, Akhter MA. Incidence and pattern of infections in diabetes mellitus A retrospective study. Int J Diab Dev Ctries. 1994;14:82-4.

23. Kumar S, Rajkumar A, Joseph A. Clinical profile of infections in type 2 diabetic patients: A hospital-based study. Int J Res Med Sci. 2018;6(3):814-9.

24. Pradeepa R, Shreya L, Anjana RM, Jebarani S, Venkatesan U, Kamal Raj N, et al. Sex-based differences in clinical profile and complications among individuals with Type 2 diabetes seen at a private tertiary diabetes care centre in India. InHealthcare 2023 Jun 2;11(11):1634.

25. Singh A, Bhatia A, Sharma P. Opportunistic infections in diabetes mellitus: A prospective study. J Clin Diagn Res. 2017;11(6):OC05-8.

26. Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol. 2021 Mar 1;9(3):174-88.

27. Viswanathan V, Puvvula A, Jamthikar AD, Saba L, Johri AM, Kotsis V, et al. Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review. World J Diabetes. 2021 Mar 15;12(3):215.

28. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3- 4):259-65. doi: 10.1111/j.1574-695X.1999.tb01397.x, PMID 10575137

29. American Diabetes Association. Introduction: Standards of medical care in diabetes-2021. Diabetes Care. 2021;44 Suppl 1:S1-2. doi: 10.2337/dc21-Sint, PMID 33298409

30. Yang YS, Han K, Sohn TS, Kim NH. Young-onset type 2 diabetes in South Korea: A review of the current status and unmet need. Korean J Internal Med. 2021 Sep 1;36(5):1049.

31. Krzymien J, Ladyzynski P. Insulin in type 1 and type 2 diabetes-should the dose of insulin before a meal be based on glycemia or meal content?. Nutrients. 2019 Mar 13;11(3):607.