Infection in Diabetes: Epidemiology, Immune Dysfunctions, and Therapeutics

Diabetes is a chronic metabolic disorder that affects approximately 10% of the global population. Unfortunately, diabetic individuals are also at a high risk of developing diabetic foot ulcers (DFUs), with an estimated 19–34% of individuals affected at some point in their lives. These DFUs are a leading cause of lower extremity amputations (LEAs), responsible for 60–70% of all cases, and have a 5-year mortality rate of approximately 49%. The mortality rate associated with DFUs is even more alarming when compared to that of all cancers, which is approximately 31%. The economic burden of DFUs is also staggering, with a global estimated cost of $78.2 billion USD. The incidence of DFUs is further compounded by the fact that 50–60% of cases develop infections, increasing the risk of amputation by 50% compared to patients with uninfected DFUs. This chapter aims to provide a comprehensive overview of infections in diabetes, with a particular focus on infections in DFUs. We will explore the microbiome shift toward pathogenic bacteria in DFU, and how this shift impacts healing outcomes. Additionally, we will examine various factors that make diabetic patients prone to infections, including dysregulations and dysfunctions in the innate immune system. Finally, we will review the conventional, unconventional, and emerging therapeutic options available to address infections in DFUs. By providing an in-depth understanding of the challenges associated with infections in diabetes, this chapter aims to contribute to the development of more effective treatment strategies that can help reduce the burden of DFUs on individuals and society as a whole.