OBJECTIVE To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control. RESEARCH DESIGN AND METHODS This retrospective cohort study included adults age ≥65 years with type 2 diabetes from an integrated health care delivery system. Negative binomial models were used to estimate incidence rates and relative risk (RR) of hospitalization for infections (respiratory; genitourinary; skin, soft tissue, and bone; and sepsis), comparing two levels of relaxed (hemoglobin A1c [HbA1c] 7% to <8% and 8% to <9%) with intensive (HbA1c 6% to <7%) glycemic control from 1 January 2019 to 1 March 2020. RESULTS Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% with HbA1c 7% to <8%, and 16.1% with HbA1c 8% to <9%), the rate of hospitalization for infections was 51.3 per 1,000 person-years. Compared with HbA1c 6% to <7%, unadjusted risk of hospitalization for infections was significantly elevated among patients with HbA1c 8% to <9% (RR 1.25; 95% CI 1.13, 1.39) but not among patients with HbA1c 7% to <8% (RR 0.99; 95% CI 0.91, 1.08), and the difference became nonsignificant after adjustment. Across categories of infections, the adjusted RR of hospitalization was significantly higher among patients with HbA1c 8% to <9% only for skin, soft tissue, and bone infection (RR 1.33; 95% CI 1.05, 1.69). CONCLUSIONS Older patients with type 2 diabetes who achieve relaxed glycemic control levels endorsed by clinical guidelines are not at significantly increased risk of hospitalization for most infections, but HbA1c 8% to <9% is associated with an increased risk of hospitalization for skin, soft tissue, and bone infections.

中文翻译：

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血糖控制放宽的 2 型糖尿病老年人的感染风险


目的 比较强化血糖控制与放松血糖控制的患者因感染住院的风险。研究设计和方法 这项回顾性队列研究包括来自综合医疗保健提供系统的 ≥65 岁 2 型糖尿病成人患者。阴性二项式模型用于估计感染（呼吸系统、泌尿生殖系统、皮肤、软组织和骨骼以及脓毒症）住院的发生率和相对风险 （RR），比较 2019 年 1 月 1 日至 2020 年 3 月 1 日两个水平的松弛（血红蛋白 A1c [HbA1c] 7% 至 <8% 和 8% 至 <9%）与强化（HbA1c 6% 至 <7%）血糖控制。结果 在 103,242 名老年患者中 （48.5% 的 HbA1c 6% 至 <7%，35.3% 的 HbA1c 7% 至 <8%，16.1% 的 HbA1c 8% 至 <9%），感染住院率为 51.3/1,000 人年。与 HbA1c 6% 至 <7% 相比，HbA1c 患者 8% 至 <9% 患者的未经调整的感染住院风险显著升高（RR 1.25;95% CI 1.13,1.39），但 HbA1c 患者 7% 至 <8% 患者则没有升高（RR 0.99;95% CI 0.91,1.08），调整后差异变得不显著。在所有感染类别中，仅皮肤、软组织和骨骼感染的 HbA1c 患者 8% 至 <9% 的校正住院 RR 显著更高 （RR 1.33;95% CI 1.05， 1.69）。结论 达到临床指南认可的放宽血糖控制水平的老年 2 型糖尿病患者在大多数感染中住院的风险并未显著增加，但 HbA1c 8% 至 <9% 与皮肤、软组织和骨感染住院风险增加相关。