European Journal of Cardiovascular Medicine

Type 2 Diabetes Mellitus (T2DM) is a major global health problem, characterized by persistent hyperglycemia and metabolic disturbances, and its prevalence continues to rise worldwide, particularly in India, which is recognized as a leading epicenter of the epidemic [1]. The disease predisposes patients to a broad spectrum of complications, among which cutaneous manifestations are both frequent and clinically significant. Indeed, the skin is often described as a “mirror of internal disease,” with dermatological changes serving as early indicators of metabolic dysregulation [2].

Cutaneous infections occur commonly in patients with diabetes due to several pathophysiological mechanisms, including impaired neutrophil function, reduced cellular immunity, microangiopathy, and compromised skin barrier integrity [3]. Poor glycemic control and longer disease duration further enhance susceptibility to opportunistic pathogens [4]. Among the various infections, fungal diseases—particularly candidiasis and dermatophytosis—are most frequently reported, followed by bacterial and viral infections [2,4]. If unrecognized or inadequately treated, these infections may contribute substantially to morbidity in affected individuals.

Although multiple studies have highlighted the dermatological burden in diabetes, the reported prevalence and spectrum of cutaneous infections differ across populations, influenced by demographic, environmental, and healthcare-related factors [5]. Context-specific data from Indian tertiary care centers are therefore valuable for guiding clinicians in timely recognition and management of these conditions.

The present study was conducted to evaluate the association between T2DM and cutaneous infections, to document their spectrum, and to analyze the influence of glycemic status and disease duration on infection prevalence.

Study Design and Setting
This was a hospital-based cross-sectional observational study conducted jointly by the Departments of General Medicine and Dermatology, Venereology and Leprosy (DVL), Government Medical College and Government General Hospital, Rajanna Siricilla, Telangana, over a period of six months from January 2025 to June 2025.

Study Population
A total of 100 patients diagnosed with Type 2 Diabetes Mellitus, attending the outpatient and inpatient services of the hospital during the study period, were included after obtaining informed consent. Both males and females aged 18 years and above were eligible.

Inclusion Criteria

Patients with established diagnosis of Type 2 Diabetes Mellitus based on American Diabetes Association (ADA) criteria.

Willingness to participate in the study and provide informed consent.

Exclusion Criteria

• Patients with Type 1 Diabetes Mellitus or gestational diabetes.
• Individuals on long-term systemic corticosteroid or immunosuppressive therapy.
• Patients with known HIV infection or other immunocompromised states.
• Those with incomplete clinical or laboratory data.

Data Collection
Demographic details (age, sex), duration of diabetes, and history of glycemic control were recorded. Glycated hemoglobin (HbA1c) levels were obtained to classify patients into controlled (< 7%) and poorly controlled (≥ 7%) categories. Each participant underwent a thorough dermatological examination by a dermatologist to identify the presence and type of cutaneous infections. In suspected cases, laboratory confirmation was performed using potassium hydroxide (KOH) mount, Gram staining, culture, or Tzanck smear, wherever appropriate.

Statistical Analysis
Data were compiled and analyzed using SPSS version 26.0. Descriptive statistics were expressed as mean ± standard deviation (SD) for continuous variables and frequencies with percentages for categorical variables. The chi-square test was applied to evaluate the association between glycemic control, duration of diabetes, and prevalence of cutaneous infections. A p-value < 0.05 was considered statistically significant.

Ethical Considerations:
The study was approved by the Institutional Ethics Committee of Government Medical College, Rajanna Siricilla. Written informed consent was obtained from all participants prior to enrollment.

A total of 100 patients with Type 2 Diabetes Mellitus were enrolled in the study. The mean age of the participants was 54.6 ± 11.2 years, with a male-to-female ratio of 1.3:1. More than one-third of patients (38%) had diabetes for over 10 years, and the majority (68%) demonstrated poor glycemic control with HbA1c ≥ 7% (Table 1).

Table 1. Demographic Characteristics of the Study Population (n = 100)

Overall, 74% of patients presented with at least one cutaneous infection, while 26% showed no dermatological manifestations (Table 2).

Table 2. Prevalence of Cutaneous Infections in Type 2 Diabetes Mellitus

Figure 1. Prevalence of Cutaneous Infections in Type 2 Diabetes Mellitus

Among those affected, fungal infections were the most common (40%), with candidiasis (22%) and dermatophytosis (18%) predominating. Bacterial infections accounted for 22%, including furunculosis (12%), cellulitis (6%), and erysipelas (4%). Viral infections were less frequent, with herpes zoster (5%) and verruca vulgaris (3%) recorded. Mixed infections, defined as the presence of two or more concurrent types, were noted in 4% of cases (Table 3).

Table 3. Spectrum of Cutaneous Infections (n = 74)

Figure 2. Spectrum of Cutaneous Infections in Type 2 Diabetes Mellitus

When glycemic control was considered, patients with poor HbA1c levels (≥ 7%) exhibited a significantly higher prevalence of cutaneous infections (85%) compared to those with controlled diabetes (50%, p < 0.05). Similarly, infection rates increased with the duration of diabetes, ranging from 58% in patients with < 5 years of disease to 88% in those with > 10 years’ duration, indicating a strong association between chronicity and infection risk (p < 0.05) (Table 4).

Table 4. Association of Cutaneous Infections with Glycemic Control and Duration of Diabetes

*Significant association (p < 0.05).

In this study, cutaneous infections were documented in 74% of patients with Type 2 Diabetes Mellitus (T2DM), confirming the considerable dermatological burden in this population. Fungal infections predominated, particularly candidiasis and dermatophytosis, followed by bacterial and viral infections. These findings align with previous literature describing fungal infections as the most frequent dermatological manifestations in diabetic patients, owing to hyperglycemia-driven impairment of innate immunity and altered cutaneous microenvironments that favor fungal proliferation [6].

The strong association between poor glycemic control (HbA1c ≥ 7%) and higher prevalence of infections (85%) highlights the central role of metabolic regulation in maintaining skin health. Similar associations between uncontrolled diabetes and increased susceptibility to candidal and bacterial infections have been emphasized in both clinical and review studies [7,8]. Chronic hyperglycemia impairs neutrophil chemotaxis, phagocytosis, and cellular immunity, thereby predisposing patients to recurrent or persistent cutaneous infections [9].

Duration of diabetes was also identified as a significant determinant, with infection prevalence rising from 58% in patients with less than five years of disease to 88% in those with more than ten years. This observation parallels earlier Indian and international studies, which demonstrated that cumulative metabolic dysregulation and microvascular complications increase skin vulnerability over time [8,10].

The predominance of fungal over bacterial and viral infections in this study may be influenced by climatic conditions, antibiotic usage, and hygiene practices, factors that have similarly been reported in large Indian cohorts [11,12]. While bacterial infections such as furunculosis and cellulitis were less common, they remain clinically important due to their potential for systemic spread. Viral infections, although relatively infrequent, still warrant attention as markers of compromised immunity.

Strengths of the study include its systematic dermatological evaluation and laboratory confirmation of suspicious cases. Nonetheless, some limitations should be acknowledged: being a single-center study with a modest sample size, the findings may not be fully generalizable. Moreover, the six-month duration did not account for seasonal variability in infection patterns.

Overall, our results corroborate the view that cutaneous infections in T2DM are not trivial complications but important clinical indicators of underlying glycemic control and chronicity. Integrating routine dermatological evaluation into diabetic care, along with patient education on hygiene and strict metabolic regulation, could significantly reduce morbidity and improve quality of life for these patients.

This study highlights the high prevalence of cutaneous infections among patients with Type 2 Diabetes Mellitus, with nearly three-fourths of individuals affected. Fungal infections, particularly candidiasis and dermatophytosis, were most frequently encountered, followed by bacterial and viral infections. The occurrence of these infections was significantly associated with poor glycemic control and longer duration of diabetes, underscoring the importance of strict metabolic regulation in reducing dermatological morbidity. These findings emphasize that skin manifestations are not only common complications but also valuable clinical markers of underlying disease status. Early recognition and integrated management may improve quality of life and prevent severe sequelae in diabetic patients.

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