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已发表论文
糖尿病与艰难梭菌感染的风险及结局：一项系统综述
Authors Zhang Q, Zhou M, Shi L, Fang Z
Received 22 August 2025
Accepted for publication 27 October 2025
Published 4 November 2025 Volume 2025:18 Pages 5685—5701
DOI https://doi.org/10.2147/IDR.S562597
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Hazrat Bilal
Qiongfang Zhang,1 Min Zhou,2 Lili Shi,3 Ze Fang2
1Department of Hospital Infection Management, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China; 2Department of Endocrinology, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China; 3Department of Geriatrics, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China
Correspondence: Ze Fang, Email fangze_med@163.com
Background: Patients with diabetes mellitus (DM) are at increased risk for Clostridioides difficile (C. difficile) infection (CDI), in part due to frequent exposure to antibiotics—particularly broad-spectrum agents—which represents the most important modifiable risk factor for CDI.
Objective: To systematically evaluate the impact of DM on the incidence and recurrence risk of CDI, explore underlying mechanisms, and provide evidence-based guidance for prevention and control in high-risk populations.
Methods: A systematic search was conducted in PubMed, Embase, and Web of Science to identify cohort and case-control studies reporting on the association between diabetes and the risk or outcomes of CDI. The ROBINS-I tool was used for risk of bias assessment. Random-effects models were applied to pool odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses, sensitivity analyses, and cumulative meta-analyses were performed. The quality of evidence for the primary outcomes was graded according to the GRADE approach. The study protocol was registered in PROSPERO (registration number: CRD420251128182).
Results: A total of 12 international studies (including 8 reporting recurrence outcomes) and covering more than 3. 5 million participants from North America, Europe, and East Asia were included. Meta-analysis showed that diabetes significantly increased the risk of CDI (OR=1. 46, 95% CI: 1. 20– 1. 77), as well as the risk of recurrence (OR=3. 11, 95% CI: 1. 98– 4. 87). Subgroup and sensitivity analyses yielded consistent results, and cumulative meta-analysis indicated that effect sizes became stable over time. Mechanistic analyses suggested that immune dysfunction, gut microbiota imbalance, and exposure to high-risk medications were key contributing factors. Based on GRADE assessment, the quality of evidence for the primary outcomes was moderate, with a low risk of publication bias.
Conclusion: Diabetes is an independent risk factor for both CDI and its recurrence. It is recommended that clinicians strengthen CDI risk assessment and integrated prevention strategies for patients with diabetes, with a focus on optimizing antibiotic stewardship, reducing unnecessary broad-spectrum antibiotic use, and microbiota-targeted interventions. High-quality prospective studies are needed to further improve prevention strategies and elucidate underlying mechanisms.
Plain Language Summary: This is the first meta-analysis to assess both the risk of developing and recurring C. difficile infection (CDI) in people with diabetes.
Diabetes increases CDI risk due to immune system problems, gut microbiota changes, and chronic inflammation.
We carefully considered antibiotic and proton pump inhibitor (PPI) use, making our results more reliable.
The findings support better infection control and prevention strategies for diabetic patients.
Special attention is needed in China and East Asia, where antibiotic use and gut microbiota patterns differ from Western countries.
Keywords: diabetes mellitus, Clostridioides difficile infection, recurrence, infection risk, mechanism, clinical outcomes
1Department of Hospital Infection Management, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China; 2Department of Endocrinology, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China; 3Department of Geriatrics, Zhongjiang County People’s Hospital, Deyang, Sichuan, People’s Republic of China
Correspondence: Ze Fang, Email fangze_med@163.com
Background: Patients with diabetes mellitus (DM) are at increased risk for Clostridioides difficile (C. difficile) infection (CDI), in part due to frequent exposure to antibiotics—particularly broad-spectrum agents—which represents the most important modifiable risk factor for CDI.
Objective: To systematically evaluate the impact of DM on the incidence and recurrence risk of CDI, explore underlying mechanisms, and provide evidence-based guidance for prevention and control in high-risk populations.
Methods: A systematic search was conducted in PubMed, Embase, and Web of Science to identify cohort and case-control studies reporting on the association between diabetes and the risk or outcomes of CDI. The ROBINS-I tool was used for risk of bias assessment. Random-effects models were applied to pool odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses, sensitivity analyses, and cumulative meta-analyses were performed. The quality of evidence for the primary outcomes was graded according to the GRADE approach. The study protocol was registered in PROSPERO (registration number: CRD420251128182).
Results: A total of 12 international studies (including 8 reporting recurrence outcomes) and covering more than 3. 5 million participants from North America, Europe, and East Asia were included. Meta-analysis showed that diabetes significantly increased the risk of CDI (OR=1. 46, 95% CI: 1. 20– 1. 77), as well as the risk of recurrence (OR=3. 11, 95% CI: 1. 98– 4. 87). Subgroup and sensitivity analyses yielded consistent results, and cumulative meta-analysis indicated that effect sizes became stable over time. Mechanistic analyses suggested that immune dysfunction, gut microbiota imbalance, and exposure to high-risk medications were key contributing factors. Based on GRADE assessment, the quality of evidence for the primary outcomes was moderate, with a low risk of publication bias.
Conclusion: Diabetes is an independent risk factor for both CDI and its recurrence. It is recommended that clinicians strengthen CDI risk assessment and integrated prevention strategies for patients with diabetes, with a focus on optimizing antibiotic stewardship, reducing unnecessary broad-spectrum antibiotic use, and microbiota-targeted interventions. High-quality prospective studies are needed to further improve prevention strategies and elucidate underlying mechanisms.
Plain Language Summary: This is the first meta-analysis to assess both the risk of developing and recurring C. difficile infection (CDI) in people with diabetes.
Diabetes increases CDI risk due to immune system problems, gut microbiota changes, and chronic inflammation.
We carefully considered antibiotic and proton pump inhibitor (PPI) use, making our results more reliable.
The findings support better infection control and prevention strategies for diabetic patients.
Special attention is needed in China and East Asia, where antibiotic use and gut microbiota patterns differ from Western countries.
Keywords: diabetes mellitus, Clostridioides difficile infection, recurrence, infection risk, mechanism, clinical outcomes