The overlooked triad: interrelationship between diabetes mellitus, diabetic foot, and acute diarrhoea. A systematic review of clinical and pathophysiological correlates.
Bibliographic record
Abstract
Background: Diabetes mellitus (DM) and its complications, particularly diabetic foot disease (DFD), substantially increase morbidity through vascular, immune, and microbiome dysfunction. Acute diarrhoeal illnesses, including Clostridioides difficile infection (CDI), antibiotic-associated diarrhoea (AAD), and cholera, can further destabilize metabolic and infectious trajectories in diabetic patients. Despite this overlap, integrated evidence on their interrelationship remains limited. Objective: To systematically evaluate current evidence on (1) the role of diabetes as a risk factor for CDI and other diarrhoeal diseases; (2) the impact of antibiotic exposure and metabolic instability on outcomes; (3) the potential protective effect of metformin therapy; and (4) the broader clinical implications for diabetic foot and inpatient management. Methods: Following PRISMA-2020 guidelines, open-access observational studies were identified in PubMed, DOAJ, PMC, Google Scholar, and OpenAIRE up to July 2025. Eligible studies included adults (≥18 years) with DM experiencing diarrhoeal illness. Outcomes analyzed were CDI incidence or recurrence, AAD occurrence, in-hospital mortality, and length of stay (LOS). Quality was assessed using the Newcastle–Ottawa Scale (NOS). Results: Six studies (2011–2024) met the inclusion criteria. Diabetes independently increased CDI risk and recurrence (OR ≈ 2.0–2.5), with antibiotic and PPI exposure as key cofactors. “4C” antibiotic use in diabetic foot ulcer patients quintupled CDI risk. Metabolic decompensation, such as diabetic ketoacidosis (DKA), significantly elevated mortality (5.8 % vs 2.7 %) and LOS. Conversely, metformin therapy reduced CDI odds by ~42 %, likely through gut-microbiota modulation. Diabetic patients with cholera showed prolonged hospitalization (IRR ≈ 2.0) without excess mortality. NOS scores (6–8/9) indicated moderate–high methodological quality. Conclusion: Diabetes amplifies susceptibility and worsens outcomes of CDI and related enteric infections, while metformin may offer partial protection. Incorporating glycaemic optimization, antibiotic stewardship, and microbiome-preserving strategies into diabetic care could mitigate infection-related morbidity and healthcare burden.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.014 | 0.017 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".