Surprisingly High Hospital Utilization for UTIs and Other Infections in Diabetes

The first known national study quantifying infection-related emergency department visits, hospital admissions, and healthcare costs for children with diabetes reveals the top infections affecting this population.

Columbus, OH — January 2018

The most common infections leading to emergency department (ED) visits or hospital admissions among children with type 1 and type 2 diabetes are those affecting the respiratory tract, skin and soft tissue, gastrointestinal system and urinary tract, according to a recent study by physician-scientists at Nationwide Children’s Hospital. The study, published in Pediatric Diabetes, may be the first to put a figure to national hospital resource utilization in the form of visit duration and cost of infection-related care among children with diabetes.

“The numbers were surprisingly high. Children and adolescents with diabetes get a lot of infections, and when they’re admitted with infections, they have longer lengths of stay and higher costs per day than patients without infections,” says Lindsey Korbel, MD, pediatric resident at Nationwide Children’s and lead author on the paper.

Dr. Korbel and John David Spencer, MD, a nephrologist at Nationwide Children’s and senior author on the paper, published similar findings on infection-related admissions and costs for diabetic adults in the Journal of Diabetes and its Complications in 2015.

“Everyone suspected this was the case with children because of known infection risks in adults with diabetes,” says Dr. Spencer. “But now we’ve put the numbers to paper and confirmed it for children with both type 1 and type 2 diabetes.”

The researchers used the Pediatric Health Information System database to identify nearly 124,000 total ED visits and hospitalizations between 2008 and 2014 for children with type 1 or type 2 diabetes, totaling charges of more than $250 million per year. While infection-related visits accounted for 14 percent of the overall visits, they racked up 30 percent of the total annual healthcare costs.

According to Drs. Spencer and Korbel, the paper is a useful reminder for physicians to have a high index of suspicion for infections and their sequelae in diabetic children.

“In general, if a child with diabetes presents with urinary complaints, any physician should be suspicious of infection,” says Dr. Spencer. “By helping these children get rapid diagnosis and early treatment, we could substantially reduce ED visits, hospitalizations and costs.”

The findings also have implications for subspecialists, he believes.

“The data revealed that although the patients we see in our Nephrology clinics don’t have longstanding diabetes like many adults, children with diabetes are still at risk for disease-related complications that can have significant impact on the kidneys, such as UTIs,” says Dr. Spencer. “Others to look out for are glucose in the urine, high blood pressure, or protein in the urine.”

While their recent publication provided evidence of the connection between diabetes and infection risk, it did not identify the causal mechanisms at play — another topic of interest to Drs. Spencer and Korbel.

“Historically, people thought that high levels of glucose in the body allowed bacteria to replicate faster in the urine, blood, or skin, resulting in increased risk of infections,” says Dr. Spencer. “But research is showing there’s more to it than just glucose; diabetes itself can suppress white blood cell function, inflammatory immune molecules and host-defense peptides that kill bacteria.”

Dr. Spencer is a principal investigator in the Center for Clinical and Translational Research at Nationwide Children’s. He is now collaborating with Dr. Korbel and other clinician-researchers to investigate how low insulin bioavailability in people with diabetes impacts immune system function.


Korbel L, Easterling RS, Punja N, Spencer JD. The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System studyPediatric Diabetes. 2017;1–8.

Korbel L, Spencer JD. Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United StatesJournal of Diabetes and its Complications. 2015;29(2):192–195.