Differential impact of glycemic control with Candida and dermatophyte infections among diabetic patients

Abstract Diabetes mellitus (DM) is a significant risk factor for fungal infections, particularly Candida and dermatophytes, and glycemic control may be associated not only with the presence of these fungi but also the pattern of these infections. This study aimed to evaluate the relationship between glycemic control (HbA1c) and the type of fungal infection among diabetic patients. A cross-sectional study was conducted on 113 diabetic patients with suspected fungal infections. Clinical samples were collected from different body sites and analyzed using phenotypic and molecular methods. Patients were stratified according to glycemic control into good (HbA1c < 6.5%), poor (HbA1c 6.5%–7.9%), and very poor (HbA1c ≥ 8.0%) groups. A significant association was observed between glycemic control and the type of fungal infection (P = 0.015). Dermatophyte infections were more common in patients with good glycemic control (64.1%), while Candida infections increased with poorer glycemic control, reaching their highest prevalence in the very poor control group (83.3%). Dermatophytes were distributed across multiple anatomical sites, whereas Candida was mainly associated with moist and occluded areas. Overall, the interdigital region was the most affected site (37.5%). Candida infections were more common in female patients (20/33, 60.6%), while dermatophyte infections were more common among male patients (28/47, 59.6%). Furthermore, diabetes duration differed significantly across glycemic control groups. These findings demonstrate a significant association between glycemic control and the pattern of superficial fungal infections in diabetic patients. Poor glycemic control was associated with increased Candida infections, whereas dermatophyte infections were more frequent in better-controlled patients, highlighting the role of glycemic status in the distribution of fungal infections.