From the Guidelines
Type 2 diabetes is not considered an immunocompromised state in the same way as conditions like HIV/AIDS or patients on immunosuppressive medications, but it can lead to immune system dysfunction that increases susceptibility to infections. According to the most recent guidelines from the Diabetes Care journal 1, type 2 diabetes accounts for 90–95% of all diabetes cases and is characterized by relative insulin deficiency and insulin resistance. While autoimmune destruction of beta-cells does not occur in type 2 diabetes, as noted in a previous study 1, the condition can still impair white blood cell function, making it harder for the body to fight off pathogens.
Some key points to consider include:
- Type 2 diabetes often goes undiagnosed for many years, and even undiagnosed individuals are at increased risk of developing macrovascular and microvascular complications 1.
- The duration of glycemic burden is a strong predictor of adverse outcomes, and effective interventions can prevent progression from prediabetes to diabetes 1.
- High blood sugar levels can impair immune function, and managing diabetes effectively through medications, regular blood glucose monitoring, proper nutrition, and exercise can help minimize this immune dysfunction.
- Diabetic patients should take standard precautions against infection, but they do not typically require extensive protective measures unless they have additional complicating factors.
Overall, while type 2 diabetes is not typically considered an immunocompromised state, it is essential to manage the condition effectively to minimize immune dysfunction and reduce the risk of infections. Effective management of type 2 diabetes, as outlined in the most recent guidelines 1, is crucial to preventing complications and improving patient outcomes.
From the Research
Immune Compromise State in Type 2 Diabetes
- Type 2 diabetes is characterized by high blood glucose levels, which can lead to a chronic inflammatory response and damage to the pancreatic beta cells, resulting in insufficient insulin production 2.
- This chronic inflammation and hyperglycemia can cause dysfunction of the immune response, making diabetic subjects more susceptible to infections 2, 3.
- The innate immune response plays a fundamental role in protecting against invading pathogens, but in patients with type 2 diabetes, this response is compromised, increasing susceptibility to infections 3.
- Studies have shown that patients with type 2 diabetes have a higher risk of infectious diseases and related comorbidities, highlighting the need for effective treatment and prevention strategies 2, 3, 4.
Increased Risk of Infections
- The compromised immune response in patients with type 2 diabetes increases their risk of infections, including influenza, which can have a more severe course in these patients 4.
- Influenza vaccination has been shown to be effective in reducing all-cause mortality and cardiovascular death in patients with diabetes, and is recommended as an integral part of treatment strategies 4.
- The use of higher-dose and quadrivalent vaccines may be more effective in patients with diabetes, although further studies are needed to confirm this 4.
Treatment and Management
- Metformin is typically the first-line pharmacotherapy for type 2 diabetes, with sulfonylureas often added as a second-line treatment 5, 6.
- However, the use of sulfonylureas has been associated with an increased risk of all-cause mortality and major hypoglycemic episodes, highlighting the need for careful consideration of treatment options 6.
- Newer oral antihyperglycemic agents may be preferred as second-line therapy for glycemic control, due to their potential for reduced risk of hypoglycemia and cardiovascular events 6.