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By Hannah Millington
Health Reporter
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Living with type 2 diabetes may double the risk of developing the potentially life-threatening condition sepsis.
Men and those younger than 60 are particularly susceptible, according to a long-term study undertaken in Australia that has been presented at the Annual Meeting of The European Association for the Study of Diabetes in Vienna.
More than 38 million Americans (1 in 10) have diabetes, of whom around 90–95 percent have type 2. This occurs when insulin doesn't work properly or there's not enough of it.
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"An association between type 2 diabetes and sepsis has been noted in some earlier studies," said study author and epidemiologist, professor Wendy Davis, from the University of Western Australia, in a statement.
"Our study, in a large community-based sample of adults, confirms a strong relationship even after adjustment for a number of potential risk factors and the competing risk of death from unrelated causes."
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Sepsis can occur as a result of any type of infection and refers to a severe, life-threatening, uncontrolled response to infection that can lead to organ failure and critical illness. It is a leading cause of death worldwide.
In the U.S., at least 1.7 million adults develop sepsis each year, of which at least 350,000 adults die during their hospitalization or are discharged to hospice.
Previous studies have found that people living with type 2 diabetes have a 2 to 6 times higher risk of sepsis and worse associated illness and death compared to people without diabetes.
But with contemporary data limited, the Australian researchers set out to bridge this knowledge gap by exploring the incidence of sepsis in a community-dwelling cohort taking part in The Fremantle Diabetes Study Phase II—a longitudinal observational study conducted in a multi-ethnic urban community of 157,000 in Australia.
"Our data analyses did not extend to mortality, but the independent strong association between type 2 diabetes and sepsis suggests that the pro-inflammatory effects of diabetes amplify those of coincident serious infections. This leads to potentially life-threatening clinical features," Davis and co-author professor Tim Davis, also of the University of Western Australia, told Newsweek.
Researchers identified 1,430 adults with type 2 diabetes at the time they enrolled, between 2008 and 2011, who were matched with 5,720 de-identified individuals without type 2 diabetes based on age, sex and postcode.
The average age of the participants at enrollment was 66 and 52 percent were men.
Their health was tracked using linked health records until the first record of incident sepsis, new onset diabetes (in the matched cohort), death or the end of 2021—whichever came first.
At enrollment, 2.0 percent of those with type 2 diabetes had a prior hospitalization for/with sepsis versus 0.8 percent of their matched counterparts without the condition.
During an average 10 years of follow-up, 169 (11.8 percent) participants with type 2 diabetes and 288 (5.0 percent) of their matched counterparts developed sepsis.
After adjustment for potential confounders including age, sex, prior hospitalization for sepsis and having other chronic conditions, type 2 diabetes was associated with double the risk of developing sepsis.
Notably, in those aged 41–50, having the condition was associated with a 14.5 times higher risk of developing sepsis.
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Further analysis revealed that among adults with type 2 diabetes, being older, male, from Aboriginal ancestry, current smoking, using insulin, having elevated fasting glucose and a higher heart rate, distal symmetrical polyneuropathy (nerve disease), cerebrovascular disease and higher levels of the heart failure biomarker NT-proBNP were all independently associated with higher risk of developing sepsis.
For example, Indigenous Australians with type 2 diabetes were three times as likely to develop sepsis. The study authors said while their findings are in an Australian context, this "may have parallels in other countries with similarly disadvantaged groups."
Meanwhile, smoking was associated with an 83 percent increased risk of sepsis, according to the team.
"Our study identifies several modifiable risk factors, including smoking, high blood sugar and complications of diabetes, underscoring that there are steps individuals can take to potentially lower their risk of sepsis," added Wendy Davis.
One of the modifiable risk factors that could be addressed, Davis and Davis explained, is "glycemic control including its long-term effects mediated through the development of macrovascular (cerebrovascular disease) and microvascular complications (peripheral neuropathy)."
"The association with NTproBNP suggests that cardiac dysfunction may also increase the adverse consequences of sepsis in people with type 2 diabetes," they added.
Several possible pathways may explain the association between type 2 diabetes and sepsis, according to the team. This includes that elevated blood sugar levels lead to impaired immune function and individuals with diabetes are also more prone to specific types of infections like urinary tract infections, skin infections and pneumonia that can readily escalate into sepsis.
Vascular damage and neuropathy, both common complications of diabetes, further contribute to the heightened sepsis risk.
The authors acknowledge no firm conclusions can be drawn about cause and effect at this stage of the observational study. They note there might have been other unmeasured factors that may have influenced the results.
Participants may also have been healthier than non-participants and the team did not take into account changes in the management of diabetes during follow-up, which could partially affect the conclusions.
"The early recognition and prompt treatment of sepsis is an obvious priority, but our data indicate that this is particularly relevant to type 2 diabetes. The present data will be further analyzed to establish the causative pathogens, short-term clinical sequelae including premature death and long-term consequences (such as persistent vital organ dysfunction and destabilized glycemic control)," Davis and Davis explained.
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Reference
W. A. Davis, Hamilton, E. J., & Davis, T. M. E. (2025). Incident sepsis in people with or without type 2 diabetes: The Fremantle Diabetes Study Phase II. EASD 2025, Vienna. https://virtualcongress.easd.org/
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