The Impact of Diabetes and Hyperglycemia in Patients Hospitalized for Dengue

Abstract

Dengue is a potentially letal mosquito-borne flavivirus disease with about 390 million worldwide infections per year. We have experienced recurrent dengue epidemics in Brazil and Paraguay. We aimed to determine the impact and clinical outcome of diabetes (DM) and hyperglycemia during hospital admission in hospitalized patients for dengue. A total of 294 patients were admitted to a single medical center. Of them,47 (16%) patients had the previous diagnosis of DM (age: 62±12 years, blood glucose [BG]: 238±116 mg/dl), 44 (14.9%) patients had hyperglycemia (BG ≥180 mg/dl) without a prior diagnosis of DM (49±18 years, BG; 165±34 mg/dl) and 214 (73%) had normoglycemia (49±19 years, BG: 110±18 mg/dl). Patients with diabetes and hyperglycemia were older and were more likely to present with severe or hemorrhagic dengue, hemodynamic shock, acute kidney injury (AKI) requiring admission to the ICU and blood transfusion, and longer length of stay. There was a single death in a non-DM patient. Compared to patients with normoglycemia, non-DM patients with hyperglycemia (≥180 mg/dl) had more severe form of dengue with AKI (9.1% vs. 20.7%, OR: 2.61), hemodynamic shock (3.4% vs. 33.3%, OR: 2.61), ICU admission (4.4% vs. 33%, p=0.03) and longer length of hospital stay (4.7 days and 7.1 days, p=0.01). Conclusion: Patients with DM and hyperglycemia were more likely to develop a more severe and hemorrhagic dengue compared to patients with normoglycemia. Because there is no specific dengue therapeutics, prevention is currently limited to vector control measures. A dengue vaccine program could represent a major advance in the control of the disease in patients with diabetes. Disclosure E.D. Bueno Colman: None. Y.A. Pozzo: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc.. U.B. Medina: None. A. Benitez: None. S.N. Marin: None.

Dengue in Pregnancy: A Southeast Asian Perspective

“…A case series from Sri Lanka showed that having GDM was associated with more severe infections such as DHF [ 47 ]. This is consistent with studies demonstrating increased severity of illness in Type 2 Diabetes Mellitus patients [ 48 ], especially those with poor glycemic control [ 50 ]. Dengue also aggravates damage in the diabetic pancreas, with evidence of macrophage infiltrates [ 51 , 53 ].…”

“…From Asia, one article took data from Asian countries broadly [ 46 ], while others used data from India [ 43 ], Sri Lanka [ 47 ], and Taiwan [ 36 , 48 ]. The literature on populations outside Asia was based on people from Poland [ 38 ], the USA [ 33 , 42 ], Denmark [ 37 ], and Brazil [ 49 , 50 , 51 ]. Articles [ 29 , 30 , 31 , 32 , 34 , 35 , 39 , 40 , 41 , 44 , 45 , 52 , 53 ] did not consider or stratify by country of origin.…”