Review
Infection and diabetes: The case for glucose control

https://doi.org/10.1016/0002-9343(82)90511-3Get rights and content

Abstract

This review summarizes data concerning the host resistance to infection in diabetes and the influence of an acute infection upon the endocrinologic-metabolic status of the diabetic patient. While it is well known that acute infections lead to difficulty in controlling blood sugar levels and that infection is the most frequently documented cause of ketoacidosis, controversy persists as to whether or not patients with diabetes mellitus are more susceptible to infection than age- and sex-matched nondiabetlc control subjects. Our data obtained from the charts of 241 diabetic patients who were being followed as outpatients show a striking direct correlation between the overall prevalence of infection (p < 0.001) and the mean plasma glucose levels (representing three or more fasting glucose determinations taken at times when no evidence of infection existed). There is a significant diminution in intracellular bactericidal activity of leukocytes with Staphylococcus aureus and Escherichia coli in subjects with poorly controlled diabetes in comparison with the control group. Serum opsonic activity for both Staph. aureus and E. coli were significantly lower than in the control subjects. Taken together, the results from published reports as well as our data suggest to us that good control of blood sugar in diabetic patients is a desirable goal in the prevention of certain infections (Candida vaginitis, for example) and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.

References (112)

  • RH Fiser et al.

    Infection with Diplococcus pneumoniae and Salmonella typhimurium in monkeys: changes in plasma lipids and lipoproteins

    J Infect Dis

    (1972)
  • JR Chandler

    Malignant external otitis: further considerations

    Ann Otol Rhinol Laryngol

    (1977)
  • CU Abengowe et al.

    Acute emphysematous cholecystitis

    Can Med Assoc J

    (1974)
  • RV Sarmiento

    Emphysematous cholecystitis

    Arch Surg

    (1966)
  • J.E. Craighead

    Viral diabetes

  • A.L. Notkins

    The causes of diabetes

    Sci Am

    (1979)
  • E.J. Rayfield et al.

    Etiologies of diabetes: viruses

  • E.J. Rayfield et al.

    Impaired carbohydrate metabolism during a mild viral illness

    N Engl J Med

    (1973)
  • D.M. Rocha et al.

    Abnormal pancreatic alpha-cell function in bacterial infections

    N Engl J Med

    (1973)
  • A.R. Colwell

    Clinical use of insulin

  • J.D.N. Nabarro

    Diabetic acidosis

  • J.A. Savin

    Bacterial infections in diabetes mellitus

    Br J Dermatol

    (1974)
  • A.G. Mowat et al.

    Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus

    N Engl J Med

    (1971)
  • J.D. Bagdade et al.

    Impaired leukocyte function in patients with poorly controlled diabetes

    Diabetes

    (1974)
  • E.J. Rayfield et al.

    Does diabetic control affect susceptibility to infection (abstr)

    Clin Res

    (1978)
  • B.R. Meyers et al.

    Rhinocerebral mucormycosis: premortem diagnosis and therapy

    Arch Intern Med

    (1979)
  • M.R. Wills et al.

    Non-clostridial gas infections in diabetes mellitus

    Br Med J

    (1960)
  • E.J. Rayfield et al.

    Viruses and the pathogenesis of diabetes mellitus

    Diabetes

    (1978)
  • J.W. Yoon et al.

    Virus-induced diabetes mellitus: isolation of a virus from the pancreas of a child with diabetic ketoacidosis

    N Engl J Med

    (1979)
  • D Younger et al.

    Infection and diabetes

  • W.R. Beisel

    Metabolic response to infection

    Annu Rev Med

    (1975)
  • R.E. McCallum et al.

    Effects of endotoxin on gluconeogenesis, glycogen synthesis and liver glycogen synthase in mice

    Infect Immun

    (1973)
  • W.R. Beisel et al.

    The impact of infectious disease on trace element metabolism of the host

  • W.R. Beisel et al.

    Metabolic effects of intracellular infections in man

    Ann Intern Med

    (1967)
  • W.R. Beisel et al.

    Metabolic balance studies during induced hyperthermia in man

    J Appl Physiol

    (1968)
  • R.W. Wannemacher et al.

    Urinary free amino acid excretion as a measure of alterations in protein metabolism during experimentally-induced infections in man

  • M.C. Powanda et al.

    Nitrogen metabolism and protein synthesis during pneumococcal sepsis in rats

    Infect Immun

    (1972)
  • J.D. Sipe et al.

    Biochemical evidence for the biphasic development of experimental amyloidosis

    Lab Invest

    (1978)
  • F Santeusanio et al.

    The role of glucagon in worsening of the diabetic state induced by infection

    Diabetes

    (1972)
  • E.J. Rayfield et al.

    Effects of acute endotoxemia on glucoregulation in normal and diabetic subjects

    J Clin Endocrinol Metab

    (1977)
  • J.E. Johnson

    Infection and diabetes

  • V Esmann

    The diabetic leukocyte

    Enzyme

    (1972)
  • A Dahlquist et al.

    The content of total and acid-soluble glycogen in the white blood cells and its relation to the staining with the periodic acid-Schiff reagent

    Acta Med Scand

    (1962)
  • V Esmann

    The glycogen content of leukocytes from diabetic and non-diabetic subjects

    Scand J Clin Lab Invest

    (1961)
  • V Esmann

    Carbohydrate metabolism and respiration in leukocytes from normal and diabetic subjects

    (1962)
  • V Esman

    The metabolism of (1-14C)-, (2-14C)-, (3,4-14C)- and (6-14C)-glucose in normal and diabetic polymorphonuclear leukocytes and during phagocytosis

    Diabetologia

    (1968)
  • J.P. Leroux et al.

    The influence of insulin on glucose permeability and metabolism of human granulocytes

    Eur J Biochem

    (1975)
  • A Marble et al.

    The nature of lowered resistance to infection in diabetes mellitus

    J Clin Invest

    (1938)
  • P.E. Perillie et al.

    Studies of the resistance to infection in diabetes mellitus: local exudative cellular response

    J Lab Clin Med

    (1962)
  • R.G. Brayton et al.

    Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis and intracellular bacterial killing

    N Engl J Med

    (1970)
  • Cited by (0)

    This work was supported in part by grants from the NIH (AM 18522), the Upjohn Company and the Herman Goldman Foundation, NIH Research Career Development Awards K04-AM-00089 (Dr. Rayfield) and K04-AI-70847 (Dr. Keusch) and RR-71 Division of Research Resources, Clinical Research Center, Mount Sinai School of Medicine.

    1

    From the Departments of Medicine and Biostatistics, Mount Sinai School of Medicine, New York, New York.

    Present address: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

    present address: Department of Geographic Medicine, Tufts University School of Medicine, Boston, Massachusetts.

    View full text