Infection risk in elderly people with reduced glycaemic control.

Johnathan Pearson-Stuttard and colleagues’ Review assessed the eff ect of glycaemic control on infection rates in people with diabetes, concluding that poor control is associated with increased infection rates. The investigators emphasised the paucity of studies specifi cally analysing the eff ect of glycaemic control on infection rates in elderly people (age >70 years). This point is particularly important because there is an emerging view that glycaemic control in elderly people can be relaxed, since the risks of developing new microvascular and macrovascular complications are substantially lower and the risks associated with hypoglycaemic episodes are often higher than in younger people. Additionally, people with diabetes are at increased risk of death from pneumonia and other infectious diseases, with elderly people being particularly vulnerable. Quantifi cation of any increased infection risk with reduced glycaemic control in this older population with diabetes is therefore particularly important. We did a large retrospective cohort analysis in 19 806 people aged 65 years or older with diabetes, with infection rates stratifi ed by glycaemic control (appendix). After adjustment for confounders, we noted that poor glycaemic control (HbA1c >8·5% [>69 mmol/mol]) was a signifi cant predictor of rates of pneumonia, urinary tract infections, and skin and soft tissue infections (table). These fi ndings emphasise the eff ect of poor glycaemic control on rates of potentially life-threatening infections in the older population. The trend towards relaxation of glycaemic control in elderly people might result in increased infection rates and possibly increased rates of hospital admission, morbidity, and mortality caused by infections. We agree with PearsonStuttard and colleagues that further research is needed, with quantifi cation of any eff ect on morbidity and mortality. Increased infection risk should be considered when relaxing glycaemic targets in elderly people.