Patients suffering from Diabetes mellitus, especially those who have long-standing diabetes and poor glycemic control, have an increased propensity to develop infections as compared to
non-diabetics. The various reasons for the same are hyperglycemia related impairment of the immune responses, vascular insufficiency, neuropathy etc. The most common infections encountered are foot infections, skin and soft tissue infections, urinary tract infections, superficial fungal infections and respiratory infections. Some infections which are significantly more prevalent in diabetics or could be critical and life-threatening infections like mucormycosis, pyelonephritis, bone and joint infections and spinal infections. Diabetes emerged as one of the prominent risk factors associated with respiratory complications and death in patients with COVID-19.
There are many challenges associated with the management of infections in diabetics. More than one organism could be responsible for the infection, i.e. the infection could be polymicrobial. Hence these patients usually require a greater number of, longer duration and higher antibiotics for treatment. The treatment outcomes are poorer and mortality rates higher in patients with diabetes, especially with poor control of sugars.
The chances of recurrence of infections, especially the foot and urinary infections, are high. Repeated intake of antibiotics by such patients puts them at risk of colonization and infection with drug-resistance organisms, which may have very limited ‘antibiotic-options’ for treatment. Also, the quality of life takes a hit in such scenarios.
Many a times, patients need surgical interventions for proper control of infection. For example, incision and drainage of abscesses, debridement and sometimes even amputation
becomes essential in patients with diabetic foot. In patients with mucormycosis, endoscopic sinus surgery is must for good results.
Infections in diabetic patients must be treated as early as possible with proper antibiotics. The help of microbiological cultures should be taken to guide treatment.
Apart from regular health check ups and sugar control, diabetic patients should take utmost care of their hygiene. They should understand the importance of ‘Feet hygiene’ and seek guidance from their doctors regarding the same. They should follow a healthy life style including healthy diet and regular exercises. Diabetics should strictly avoid tobacco intake and smoking as they worsen the health of blood vessels, nerves and lung function, all of which contribute to the risk of acquiring various infections. All age appropriate vaccines should be taken by diabetic patients, with the advice from the expert.
Prevention and treatment of infections in diabetics, if done in a systematic manner, under proper guidance, can improve the results significantly.
