Extreme HbA1c values shows association with a higher sepsis occurrence

In a new study led by Anca Balintescu and colleagues, researchers discovered association between HbA1c and sepsis, as well as a fourfold increased risk of death among those developing sepsis. The findings of this study were published in the Journal American Diabetes Association.

In 2017, there were nearly 50 million cases of sepsis and 11 million sepsis-related deaths worldwide. Although the link between diabetes and infection and sepsis is well established, studies looking at risk factors for sepsis in people with type 2 diabetes (T2D) have been limited by a failure to account for potential confounders.

The goal of this study was to look into the nature of the relationship between HbA1c and sepsis in people with type 2 diabetes, as well as the relationship between sepsis and all-cause mortality in these people.

Researchers used multivariable Cox regression and restricted cubic spline analyses to assess the relationship between time-updated HbA1c values and sepsis occurrence between January 1, 2005, and December 31, 2015. A multivariable Cox regression analysis was used to investigate the link between sepsis and death.

The findings of this study were states as follows:

1. During the study period, 14,534 patients (2.9 percent) developed sepsis.

2. The adjusted hazard ratio for sepsis was 1.15 (95 percent CI 1.07–1.24) for HbA1c 43 mmol/mol (6.1 percent), 0.93 (0.87–0.99) for HbA1c 53–62 mmol/mol (7.0–7.8 percent), 1.05 (0.97–1.13) for HbA1c 63–72 mmol/mol (7.9–8.7 percent), and 1.14 (1.04–1.25) for H (9.7 percent ).

3. In the cubic spline model, the adjusted risk was reduced within the lower HbA1c range until 53 mmol/mol (7.0 percent), with a hazard ratio of 0.78 (0.73–0.82) per SD; it then increased (P for nonlinearity 0.001).

4. The adjusted hazard ratio for death among patients with sepsis was 4.16 (4.03–4.30) when compared to patients without sepsis.

In conclusion, these findings are consistent with previous research that found a U- or J-shaped relationship between HbA1c and other outcomes like mortality and cardiovascular disease. Even after controlling for relevant comorbid conditions, extreme HbA1c values were associated with a higher hazard ratio for sepsis.

Reference:

Balintescu, A., Lind, M., Franko, M. A., Oldner, A., Cronhjort, M., Svensson, A.-M., Eliasson, B., & Mårtensson, J. (2021). Glycemic Control and Risk of Sepsis and Subsequent Mortality in Type 2 Diabetes. In Diabetes Care (p. dc211050). American Diabetes Association. https://doi.org/10.2337/dc21-1050