Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976–1979 in The Netherlands

Bouter, K.P.; Diepersloot, R.J.A.; Romunde, L. K. J. Van; Uitslager, R; Masurel, N.; Hoekstra, J. B. L.; Erkelens, D. W.

doi:10.1016/0168-8227(91)90131-v

Cited by 59 publications

(38 citation statements)

References 18 publications

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“…Moreover, ours is the only study to have adjusted for comorbidities, vaccination status and cyclic trends apart from influenza. Insofar as diabetes was found to be a risk factor for influenza-attributable hospitalisations, our results agree with those of previous seasonal influenza studies [11][12][13] as well as those of certain pH1N1 studies [45]. In contrast to previous studies, the effect we demonstrated was much smaller and subtler in magnitude.…”

Section: Discussioncontrasting

confidence: 56%

“…Finally, Neuzil et al reported a fivefold (unadjusted) higher rate of influenza-attributable cardiopulmonary hospitalisations or deaths in working-age women with diabetes [12]. The limitations of these studies include potential bias from the use of hospital-based comparison groups [11], lack of adjustment for comorbidities and vaccination status [11][12][13] and inadequate adjustment for seasonality [12], as mentioned earlier. Additionally, several studies have examined the effects of diabetes on pH1N1 influenza.…”

Section: Discussionmentioning

confidence: 99%

“…Schanzer et al noted increased influenza-attributable primary respiratory admissions in patients with diabetes compared with those without diabetes, but did not report diabetes-specific risk estimates [13]. Bouter et al found that diabetes increased the risk of both pneumonia hospitalisations and subsequent mortality to a greater extent during years with significant influenza activity Counts and rates for adults without diabetes were estimated for the matched comparison group of non-diabetic subjects, and therefore do not represent the actual numbers of influenza-attributable outcomes in adults in Manitoba without diabetes a 'Projected' minus 'counterfactual' [11]. Finally, Neuzil et al reported a fivefold (unadjusted) higher rate of influenza-attributable cardiopulmonary hospitalisations or deaths in working-age women with diabetes [12].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only three studies have compared the burden of seasonal influenza in adults with and without diabetes. These studies have several limitations, including potential bias from the use of hospital-based comparison groups [11], lack of adjustment for comorbidities and vaccination status [11][12][13] and inadequate adjustment for seasonality [12]. More recently, studies of pandemic H1N1 (pH1N1) influenza have drawn varying conclusions regarding the extent to which diabetes increases the risk of severe outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Working-age adults with diabetes experience greater susceptibility to seasonal influenza: a population-based cohort study

et al. 2014

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Aims/hypothesis The aim of this work was to compare the incidence of illness attributable to influenza in working-age adults (age <65 years) with and without diabetes. Methods We performed a cohort study using administrative data from Manitoba, Canada, between 2000 and 2008. All working-age adults with diabetes were identified and matched with up to two non-diabetic controls. We analysed the rates of influenza-like illness physician visits and hospitalisations, pneumonia and influenza hospitalisations, and all-cause hospitalisations. Multivariable regressions were used to estimate the influenza-attributable rate of each outcome. Results We included 745,777 person-years of follow-up among 166,715 subjects. The median age was 50-51 years and 48-49% were women; adults with diabetes had more comorbidities and were more likely to be vaccinated for influenza than those without diabetes. Compared with similar adults without diabetes, those with diabetes had a 6% greater (RR 1.06, 95% CI 1.02, 1.10; absolute risk difference 6 per 1,000 adults per year) increase in all-cause hospitalisations associated with influenza, representing a total of 54 additional hospitalisations. There were no differences in the influenzaattributable rates of influenza-like illness (p = 0.06) or pneumonia and influenza (p = 0.11). Conclusions/interpretation Guidelines calling for influenza vaccinations in diabetic, in addition to elderly, adults implicitly single out working-age adults with diabetes. The evidence supporting such guidelines has hitherto been scant. We found that working-age adults with diabetes appear more susceptible to serious influenza-attributable illness. These findings represent the strongest available evidence for targeting diabetes as an indication for influenza vaccination, irrespective of age.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Working-age adults with diabetes experience greater susceptibility to seasonal influenza: a population-based cohort study

et al. 2014

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“…The combination of a recent influenza infection combined with diabetic ketoacidosis likely provided the setting for colonization [24,25] and subsequent invasion of the lung parenchyma by Aspergillus. Our patient was negative for Aspergillus antibody, implying that the patient was in an immunosuppressive state and the fungal infection was neither subacute nor chronic one.…”

Section: Discussionmentioning

confidence: 99%