Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain

Abstract

Objectives To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory‐confirmed A(H1N1)pdm09 infections in Spain during 2009. Methods Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD‐9‐CM code 488·1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in‐hospital case fatality risk, length of hospital stay, and costs. Results The total number of persons hospitalized with A(H1N1)pdm09 was 11 499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26·8%), and for Type 1 renal disease (10·3%). In‐hospital mortality was 2·1% among Type 1 patients, 3·8% among Type 2 patients, and 2·3% among non‐diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1·03; 95% CI1·01–1·05), hematological disorders (OR 3·49; 95% CI, 1·46–8·37), and obesity (OR 1·88; 95% CI1·07–3·92). Conclusions Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age‐specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.

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

“…Moreover, since over one-third of diabetes is undiagnosed in the community [48], the lack of a population control group in case series of pH1N1 hospitalisations makes it difficult to ascertain whether the apparent effect of diabetes on pH1N1 hospitalisations is due to increased detection of diabetes in tertiary care. The prevalence of diabetes in pH1N1 patients may be consistent with its community prevalence if undiagnosed diabetes is included [46]. To our knowledge, our study is one of only two studies [12] to have identified and followed individuals, in the general population, with and without diabetes, for influenzaattributable outcomes.…”

“…Diabetes appears disproportionately represented in most studies of confirmed pH1N1 cases requiring hospitalisation [36,[42][43][44][45]. Some pH1N1 studies have also identified diabetes as a risk factor for severe outcomes following hospitalisation [45], although other studies have not [46,47]. Whether the high prevalence of diabetes in pH1N1 studies can be attributed to a diabetes-effect on risk [45], confounding due to other comorbidities [46,47] or due to adults with diabetes being more readily admitted on a precautionary basis [35] remains unclear.…”

“…Some pH1N1 studies have also identified diabetes as a risk factor for severe outcomes following hospitalisation [45], although other studies have not [46,47]. Whether the high prevalence of diabetes in pH1N1 studies can be attributed to a diabetes-effect on risk [45], confounding due to other comorbidities [46,47] or due to adults with diabetes being more readily admitted on a precautionary basis [35] remains unclear. Moreover, since over one-third of diabetes is undiagnosed in the community [48], the lack of a population control group in case series of pH1N1 hospitalisations makes it difficult to ascertain whether the apparent effect of diabetes on pH1N1 hospitalisations is due to increased detection of diabetes in tertiary care.…”

Infection Studies in Pigs and Porcine Airway Epithelial Cells Reveal an Evolution of A(H1N1)pdm09 Influenza A Viruses Toward Lower Virulence

“…In the first year of the pandemic, infections resulted in >100 000 deaths worldwide [2][3][4]. Increased lethality was particularly observed in patients with diabetes and obesity, but also in pregnant women [5][6][7]. The majority of infections, however, had a less severe course of disease [8].…”

Identification of Rare PB2-D701N Mutation from a Patient with Severe Influenza: Contribution of the PB2-D701N Mutation to the Pathogenicity of Human Influenza

“…It needs to be considered that diabetes, is among the comorbidities involved in a severe outcome of influenza virus infection and it triples the risk of hospitalization after influenza A(H1N1)pdm09 infection (Jimenez-Garcia et al, 2013). However, the results of multivariate analysis have suggested that possibly concomitant conditions such as obesity, frequently found among diabetic persons, highly increases the risk of very severe infection or even death, and not only diabetes itself (Jimenez-Garcia et al, 2013). The patient from whom A/Aragón/270/2014 virus was isolated did not have obesity and his levels of glycated hemoglobin were within the levels of the control population indicating a good control of blood glucose levels upon infection.…”