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Change from oral antidiabetic therapy to insulin and risk of urinary tract infections in type 2 diabetic patients: a population-based prescription study

Abstract number: P1623

Sanden A.K., Johansen M.B., Pedersen L., Lervang H.H., Schønheyder H.C., Sørensen H.T., Thomsen R.W.

Objective: Diabetes is a risk factor for urinary tract infections (UTI). This study assessed whether a change from oral antidiabetic drug (OAD) to insulin therapy with improved glycemic control decreased the rate of antibiotic prescriptions for UTI among Type 2 diabetics.

Method: We used population-based healthcare databases to identify 2,843 Type 2 diabetic patients who switched from OAD to insulin therapy. Each patient was observed for 365 days before and after the change. Episodes of UTI were defined as filled prescriptions for a UTI-specific antibiotic. We used conditional logistic regression to estimate the relative risk (odds ratio (OR)) of having at least one UTI in the insulin vs. OAD period, both overall and stratified by improvements in glycemic control.

Results: The overall period prevalence of UTI was 15.6% in the OAD period and 15.9% in the insulin period. The OR for a UTI episode in the insulin period compared to the OAD period was 1.05 (95% CI 0.87–1.26). After the change to insulin therapy, 53% of all patients experienced a decrease in mean HbA1c level (median decrease=1.5%, interquartile range 0.93%-2.30%). Stratifying by gender, we found a period prevalence of 23.3% among women and 7.3% among men in the OAD period, compared to 24.0% among women and 8.2% among men in the insulin period. The corresponding ORs were 0.98 (95% CI: 0.78–1.22) for women and 1.25 (95% CI: 0.87–1.79) for men. The most pronounced effect of insulin therapy initiation on UTI risk was observed for patients of both genders with a high baseline comorbidity level, a history of UTI treatment, and age less than 65 years at study entry (ORs between 0.67 and 0.85). However, statistical precision was limited

We did not find a consistent effect of level of glycemic improvement on UTI risk.

Conclusion: Initiation of insulin treatment with or without tightened glycemic control had no impact on risk of treated UTI in Type 2 diabetic patients.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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