Background and study aim: In developing countries with high diabetes rates, it is essential to recognize the effect of infection ‎on the glycemic control. The purpose was to determine how infection affects glycemic control, ‎specifically HbA1c. The secondary objective was to compare infection-related outcomes between ‎good versus poorly controlled diabetes‎‎‎‎‎‎‎.‎
Methods: ‎‎‎A cohort study conducted from July 2019 to June 2020 at the Aga Khan University Hospital, ‎Karachi. A patient's HbA1c before infection is called pre-infection HbA1c; the HbA1c after 3 ‎months is called post-infection HbA1c. Pre-infection HbA1c were subcategorized into two groups, ‎i.e. poor and good glycemic control. Comparison of infection related outcomes between these two ‎groups was done using the chi-square test‎‎‎‎.‎
Results: A total of 168 patients had infection and diabetes. The mean age was 67.6 years and 86 (51.2%) ‎were males. Seventy patients (41.7%) had good-control, while 98 patients (58.3%) had poor-‎control. The mean pre-infection HbA1c in good-control diabetic patients was 6.2% while in poor-‎control was 8.5% (p: 0.000). While the mean post-infection HbA1c in the good-control was 6.9% ‎and in the poor-control was 8.3% (p: 0.010). The poor-control group had a higher infection-related ‎death rate (62.5% vs. 37.5%, p: 0.72), and multiple sites of infection (65.2% vs. 34.8%, p: 0.47). In ‎the poor-control group, there was a higher rate of re-infection (52.8 vs. 47.2%, p: 0.45), whereas ‎the rate of septic shock was similar (50%, p: 0.42)‎‎‎‎‎‎.
Conclusion: Based on our study, we conclude that infection had variable effect on glycemic control ‎. ‎Moreover, diabetes per se had a major effect on infection risk, its severity, and mortality, regardless ‎of glycemic control‎‎‎‎.