From the Guidelines
Yes, diabetes does put you at increased risk for cellulitis. People with diabetes are more susceptible to developing this skin infection due to several factors related to their condition. High blood sugar levels can weaken the immune system, making it harder for the body to fight off bacterial infections that cause cellulitis. Diabetes also often leads to poor circulation, particularly in the extremities, which reduces the delivery of infection-fighting cells to areas where bacteria may enter the skin. Additionally, many diabetics experience neuropathy (nerve damage), which can result in unnoticed cuts or injuries that become entry points for bacteria. Diabetes-related skin changes, including dryness and cracking, further increase vulnerability by compromising the skin's protective barrier. For diabetic individuals, proper foot care is especially important, including daily inspection for cuts or sores, keeping skin moisturized, managing blood sugar levels, and seeking prompt medical attention for any skin injuries or signs of infection. Early treatment of cellulitis is crucial to prevent serious complications, which can be more severe in people with diabetes 1, 2, 3, 4, 5.
Key Factors Increasing Risk
- High blood sugar levels weakening the immune system
- Poor circulation reducing delivery of infection-fighting cells
- Neuropathy leading to unnoticed cuts or injuries
- Diabetes-related skin changes compromising the skin's protective barrier
Importance of Proper Foot Care
- Daily inspection for cuts or sores
- Keeping skin moisturized
- Managing blood sugar levels
- Seeking prompt medical attention for any skin injuries or signs of infection
Treatment Considerations
- Antibiotic treatment active against streptococci and S. aureus
- Consideration of systemic corticosteroids in nondiabetic adult patients with cellulitis, as per the Infectious Diseases Society of America guidelines 5
- Elevation of the affected area to promote gravity drainage of edema and inflammatory substances
- Treatment of underlying conditions that may have predisposed to the infection, such as tinea pedis or venous eczema
Preventing Recurrences
- Treating interdigital maceration
- Keeping the skin well hydrated with emollients
- Reducing underlying edema through elevation, compressive stockings, or pneumatic pressure pumps
- Consideration of prophylactic antibiotics in cases of frequent infections 4
From the Research
Diabetes Mellitus and Cellulitis Risk
- Diabetes mellitus (DM) is a systemic illness that can cause a broad range of physiologic effects, including increased risk for wounds and complex soft tissue infections such as cellulitis 6.
- Studies have shown that diabetes predisposes to common infections, including cellulitis, and that poor glycemic control is associated with an increased risk of cellulitis 7.
- The correlation between the level of glycemic control and the rate of infection is significant, with a 1.4-fold increased risk of cellulitis among patients with HbA1c >7.5% (58 mmol/mol) 7.
- Factors such as obesity, Parkinson's disease, peripheral vascular disease, and prior treatment with prednisone also predispose to cellulitis 7.
Microbiology and Antibiotic Treatment
- The microbiology of cellulitis and cutaneous abscess is not well established, but studies have shown that aerobic gram-positive organisms are commonly isolated in both diabetics and non-diabetics 8.
- Diabetics are more likely to be exposed to broad gram-negative therapy, suggesting that this prescribing practice may not be warranted 8.
- Current insights into the pathophysiology of cellulitis highlight the importance of the physical skin barrier, the immune system, and the circulatory system, all of which can be impaired in diabetes 9.
Risk of Infection in Diabetes
- Adults with diabetes have a higher risk of infection compared to the general population, with the highest incidence rate ratios (IRRs) seen for bone and joint infections, sepsis, and cellulitis 10.
- Patients with type 1 diabetes mellitus (T1DM) have a higher risk of infection-related hospitalizations and deaths compared to those with type 2 diabetes mellitus (T2DM) 10.
- Strategies to reduce the risk of developing severe infections and poor treatment outcomes in people with diabetes are under-researched and should be explored 10.