Abstract / Summary
Background: /Objectives: Diabetes is associated with increased susceptibility to infection, while acute infection may worsen clinical severity and disturb short-term glucose regulation. Saudi data directly comparing urinary tract infection (UTI), sepsis, and diabetes without documented infection remain limited. This study compared glycaemic measures and recorded acute outcomes across these groups.
Methods: We conducted a retrospective hospital-based cohort analysis of 596 eligible adult diabetes-related records from King Salman Specialist Hospital, Hail, Saudi Arabia, between 2021 and 2025: 209 UTI records, 84 sepsis records, and 303 records without documented infection. Available HbA1c, random blood glucose (RBG), fasting blood glucose (FBG), white blood cell count (WBC), and recorded death, intensive care unit (ICU) admission, and hospitalization were analyzed. Relative risks (RRs) were calculated, and generalized estimating equations with a modified Poisson model and patient-level clustering were used to estimate adjusted RRs.
Results: Median HbA1c did not differ significantly across the no-infection, UTI, and sepsis groups (7.9%, 8.3%, and 7.8%, respectively; p=0.206), whereas WBC was markedly higher in sepsis. Recorded mortality was 1.0%, 10.0%, and 46.4%, and ICU admission was 3.0%, 16.3%, and 78.6%, respectively. After adjustment for age, sex, BMI, hypertension, chronic kidney disease, and cardiovascular disease, the adjusted RR for recorded death was 13.36 (95% CI 3.09-57.76) for UTI and 49.80 (11.73-211.48) for sepsis; corresponding adjusted RRs for ICU admission were 6.31 (2.83-14.10) and 24.82 (11.49-53.60).
Conclusions: UTI and especially sepsis were associated with substantially greater recorded acute clinical severity, despite broadly similar HbA1c distributions. These associations should not be interpreted as causal because the analysis was retrospective, acute glucose measurements were incomplete, and outcome documentation was based on the available medical-record fields.