Abstract
BACKGROUND: Infection is a significant complication of diabetes, yet comprehensive assessments of risk factors for infections in individuals with diabetes are scarce. We aimed to identify risk factor profiles and their contributions to infections in people with type 2 diabetes (T2D). METHODS: This prospective cohort study included 24,021 participants with T2D. Twenty-eight risk factors covering domains of socioeconomic status, lifestyle factors, environmental pollution, psychological factors, clinical biomarkers, and comorbidities and complications were selected. Negative binomial regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for infections. Population attributable fractions (PAFs) were calculated to assess the contributions of individual risk factors and domains. RESULTS: During a median follow‑up of 13.2 years, 9988 infection events occurred among 6517 participants, with an overall incidence rate of 33.5 per 1000 person‑years. Nineteen risk factors were significantly associated with increased infection risks, including high Townsend deprivation index, low education level, low household income, retired or unemployed status, central obesity, unhealthy diet, current smoking, non‑moderate alcohol consumption, unhealthy sleep duration, depression, loneliness, high glycated hemoglobin, low high-density lipoprotein cholesterol, low estimated glomerular filtration rate, cancer, cardiovascular disease, peripheral artery disease, diabetic microvascular complications, and chronic obstructive pulmonary disease. Central obesity was the leading individual contributor to total infections (PAF, 13.2%). Across domains, lifestyle factors contributed most to total infections (joint PAF, 32.7%), followed by socioeconomic status (joint PAF, 26.3%), comorbidities and complications (joint PAF, 25.2%), clinical biomarkers (joint PAF, 17.1%), psychological factors (joint PAF, 6.3%), and environmental pollution (joint PAF, 3.3%). CONCLUSIONS: This study identified a broad array of risk factors for infections in adults with T2D, indicating the importance of comprehensive management strategies for preventing infections among individuals with T2D.