Chikungunya Virus Infection and Diabetes Mellitus: A Double Negative Impact

Abstract

The impact of chikungunya virus (CHIKV) infection on diabetic patients (DPs) has not been described. We aimed to compare clinical features of CHIKV infection in DPs and nondiabetic patients (NDPs), and to evaluate its effects on glycemic control among DPs. We recorded clinical information and, in DPs, glycemic control. Forty-six DPs and 53 NDPs aged ≥ 20 years living in Haiti, with acute CHIKV infection, were studied. Diabetes duration was 7.1 ± 6.1 years. The most common acute CHIKV clinical manifestations were arthralgia (100.0% DPs and 98.1% NDPs, P = 1.000) and fever (86.9% DPs and 90.5% NDPs, P = 0.750). In DPs as compared with NDPs, arthralgia was more intense (mean pain score of 6.0/10 ± 2.2 versus 5.1/10 ± 2.0, P = 0.04) and took longer to improve (8.2 ± 3.0 versus 3.5 ± 2.5 days, P < 0.0001). Severe arthralgia was more prevalent (58.7% versus 20.8%, P = 0.0002), as was myalgia (80.4% versus 50.9%, P = 0.003), and fever lasted longer (5.1 ± 1.8 versus 3.7 ± 1.7 days, P = 0.0002). Among DPs, median fasting capillary glucose before versus after disease onset was 132.5 and 167.5 mg/dL (P < 0.001), corresponding to a median increase of 26.8% (interquartile range: 14.4–50.1%). Antidiabetic medication was titrated up in 41.3%. In summary, among DPs, CHIKV infection has a significant negative impact on glycemic control and, compared with NDPs, results in greater morbidity. Close clinical and glycemic observation is recommended in DPs with CHIKV infection.

Prevalence of chronic comorbidities in chikungunya: A systematic review and meta-analysis

“…Systematic analysis of studies that described the epidemiological, demographic and clinical features of CHIKV cases and reported the prevalence of a number of chronic diseases in the infectious disease, has identified 11 reports (Arroyo-Avila et al, 2017;Economopoulou et al, 2009;Padmakumar et al, 2010;Jean-Baptiste et al, 2016;Sá deOliveira et al, 2017;Perti et al, 2016;Crosby et al, 2016;Chusri et al, 2014;Couturier et al, 2012;Tandale et al, 2009;Borgherini et al, 2007) with 2,773 patients (Table 1). This limited number of reports is the result of our strict search strategy and selection criteria and our focus only on the studies recording the prevalence of comorbidities in CHIKV.…”

“…Ten articles were excluded at the full text review stage as they were either not related to the study objectives (4 studies), not reporting prevalence of chronic disease in CHIKV (3 studies), case reports with small numbers of cases (i.e., <3 cases; 2 reports), or a review article (see Figure 1 and Supplementary Table S1). After identifying one study through bibliography searching, 11 reports were included for systematic review and meta-analysis (Arroyo-Avila et al, 2017;Economopoulou et al, 2009;Padmakumar et al, 2010;Jean-Baptiste et al, 2016;Sá deOliveira et al, 2017;Perti et al, 2016;Crosby et al, 2016;Chusri et al, 2014;Couturier et al, 2012;Tandale et al, 2009;Borgherini et al, 2007).…”

“…Epidemiologic evidence suggests that CHIKV patients at risk of severe disease outcomes are elderly subjects (Godaert et al, 2017) and those with certain comorbidities, e.g., obesity (Padmakumar et al, 2010), diabetes (Jean-Baptiste et al, 2016), cardiac diseases (Alvarez et al, 2017), and asthma (Paganin et al, 2010). The presence of these comorbidities was proposed to predispose CHIKV patients to severe complications of the viral infection (Padmakumar et al, 2010;Jean-Baptiste et al, 2016;Alvarez et al, 2017;Paganin et al, 2010). However, the prevalence of co-existing medical conditions in severe CHIKV cases has not been described.…”

Chikungunya Virus Infection: Why Should U.S. Geriatricians Be Aware of It?

“…The exacerbation of underlying chronic comorbid conditions by CHKV has been studied in individuals with diabetes mellitus. The infection may worthen the glycemic control and results in greater morbidity than in individuals without diabetes mellitus . Working from the electronic medical recard of the Veterans Health Administration System, one study reported that overall mortality at the acute stage was low.…”

“…The infection may worthen the glycemic control and results in greater morbidity than in individuals without diabetes mellitus. 33 Working from the electronic medical recard of the Veterans Health Administration System, one study reported that overall mortality at the acute stage was low. However, and similarly to what was described for seasonal influenza infection, 35 the mortality related to CHIKV is also probably delayed to months after the acute phase.…”