Transcending risk factors: the implications of redefining diabetes as an immunometabolic disease for infectious disease studies

This review methodically argues for a theoretical paradigm shift. The text redefines diabetes as an “immunometabolic disorder” and explores its profound implications. Conventional wisdom has long regarded diabetes as a risk factor for infectious disease comorbidity. Nevertheless, this perspective lacks the depth necessary to elucidate the underlying mechanisms involved. Preliminary clinical research suggests that individuals with diabetes have a 2- to 4-fold higher probability of requiring hospitalization due to infections in comparison with individuals who do not have diabetes. During the pandemic, there was a notable surge in severe illness and mortality rates. These findings suggest limitations in the traditional explanatory framework centered solely on glycemic control. The new paradigm focuses on the co-dysregulation of immunity and metabolism, elucidating how factors such as hyperglycemia and lipotoxicity interact to ultimately drive chronic inflammation and immune dysfunction. This framework elucidates the underlying mechanisms that render individuals with diabetes more vulnerable to various pathogens, expedite disease progression following infection, and manifest diminished therapeutic and vaccine responses. The review further posits that this understanding should inform clinical practice. Rather than prioritizing solely glycemic control, a comprehensive approach to management should encompass metabolic regulation, immune assessment, and infection prevention. Public health policies must explicitly categorize diabetic patients as a priority group for protection. Despite the challenges associated with precise subtyping and the development of targeted interventions, the potential benefits of interdisciplinary efforts and precision medicine strategies are noteworthy. A critical imperative for diabetes management is a transition from a blood glucose control-centric approach to a comprehensive intervention strategy aimed at restoring immune-metabolic homeostasis.