Diabetic Ketoacidosis During the Influenza Epidemic

Watkins, P J; Soler, Norman G.; Fitzgerald, M. G.; Malins, J. M.

doi:10.1136/bmj.4.5727.89

Cited by 33 publications

(23 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A further 9 (4-6 %) had accepted because they considered the vaccine was generally worthwhile and 10 (5-2 %) because they felt that they were at increased risk from influenza; 11 respondents (5-7 %) gave other reasons for acceptance such as media publicity, general practitioners' publicity, 'force of habit' and the offer of vaccine made in the workplace. DISCUSSION Whilst the groups studied do not represent the full range of patients with medical conditions for which vaccine is recommended [6], the increased risk of complications from influenza (including death) in patients with chronic cardiovascular and respiratory disease, and diabetes has been well documented [10,[15][16][17]. Moreover, of the chronic medical conditions for which vaccine is indicated, those studied are numerically important because of their high prevalence in the community [14], and the nature and severity of illness in our chosen subjects had brought them into regular contact with general practitioners (mean of 6-7 consultations in past 12 months) and hospital services (mean of 4 9 out patient visits in past 12 months).…”

Section: Resiults Basic Demographymentioning

confidence: 99%

Influenza immunization; vaccine offer, request and uptake in high-risk patients during the 1991/2 season

Nguyen-Van-Tam

Nicholson

1993

Epidemiol. Infect.

View full text Add to dashboard Cite

SUMMARYCurrent levels of influenza vaccine uptake in patients considered to be at high risk have been determined by means of a questionnaire survey. During March-April 1992, information was sought from 624 patients in Leicestershire, UK with either chronic cardiovascular or respiratory disease, or diabetes; questions related to current health status and the request, offer and receipt of influenza vaccine in the current and three previous seasons. Ninety-eight percent of all offers of immunization were made in the primary care setting, and vaccine was well tolerated as judged by the fact that 86 % of vaccinees between 1988/9-1990/1 returned for immunization in the following year. However in the 1991/2 season the overall level of vaccine uptake was only about 41 % which is at variance with the stated policies and practices of general practitioners. Opportunities were missed, in both hospitals and general practices, to publicise and offer immunization to individuals with vaccine indications. Future attempts to improve vaccine uptake should focus on increasing the role of hospital staff in influenza prevention, in addition to promoting better vaccine delivery through primary care.

show abstract

Section: Resiults Basic Demographymentioning

confidence: 99%

Influenza immunization; vaccine offer, request and uptake in high-risk patients during the 1991/2 season

Nguyen-Van-Tam

Nicholson

1993

Epidemiol. Infect.

View full text Add to dashboard Cite

show abstract

“…Currently, the prevalence of type 2 diabetes is rising rapidly in many countries due to population aging and increasing prevalence of obesity (4). Patients with diabetes may carry a higher case fatality of invasive pneumococcal disease than nondiabetic patients (5,6) due to risk of metabolic derangement caused by severe infection per se (7), decreased immunity (8), generally decreased tissue oxygenation, or pulmonary microangiopathic changes (9). Moreover, diabetes is associated with a high prevalence of adverse prognostic factors for pneumococcal bacteremia, including old age and comorbidity.…”

mentioning

confidence: 99%

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

et al. 2004

View full text Add to dashboard Cite

OBJECTIVE -Patients with diabetes may carry a higher case fatality of invasive pneumococcal infection compared with nondiabetic patients due to decreased immunity, risk of metabolic derangement, or angiopathy. We conducted a population-based cohort study to assess the impact of diabetes on mortality within 90 days in patients with pneumococcal bacteremia.RESEARCH DESIGN AND METHODS -All patients with community-acquired pneumococcal bacteremia in North Jutland County, Denmark, from January 1992 to December 2001 were retrieved from the County Bacteremia Registry. Using civil registry numbers, patients with diabetes were identified by record linkage with the County Prescription Database (for antidiabetic drugs) and the County Hospital Discharge Registry. Mortality within 90 days was determined through the Central Population Registry. Mortality rates were compared for diabetic and nondiabetic patients and adjusted for sex, age, and comorbidity.RESULTS -Among 628 patients aged Ͼ15 years with community-acquired pneumococcal bacteremia, 63 (10.0%) had diabetes. The diabetic patients were slightly older (median age 71.7 years) than the nondiabetic patients (67.0 years), and the proportion of patients with comorbidity was higher in the diabetic group (59 vs. 46%). Mortality in diabetic patients compared with nondiabetic patients was 11.1 vs. 16.5% after 30 days and 16.0 vs. 19.5% after 90 days, respectively. After adjustment for sex, age, and comorbidity, the mortality rate ratio for diabetic patients was 0.6 (95% CI 0.3-1.2) compared with the nondiabetic patients.CONCLUSIONS -Diabetic patients with community-acquired pneumococcal bacteremia appear not to have a higher case fatality than nondiabetic patients. Diabetes Care 27:70 -76, 2004P neumococcal bacteremia is a lifethreatening disease, with in-hospital case fatality estimated at 12-36% (1-3). Advanced age and comorbidity have been associated with fatal outcome. Currently, the prevalence of type 2 diabetes is rising rapidly in many countries due to population aging and increasing prevalence of obesity (4). Patients with diabetes may carry a higher case fatality of invasive pneumococcal disease than nondiabetic patients (5,6) due to risk of metabolic derangement caused by severe infection per se (7), decreased immunity (8), generally decreased tissue oxygenation, or pulmonary microangiopathic changes (9). Moreover, diabetes is associated with a high prevalence of adverse prognostic factors for pneumococcal bacteremia, including old age and comorbidity.Data are sparse concerning the outcome of invasive pneumococcal infection in patients with diabetes (10). Previous case series of pneumococcal bacteremia (1,2,11-14) have been hampered by small numbers of diabetic patients, cohorts from specialized hospitals, or lack of follow-up after hospital discharge. In the present population-based cohort study, we examined whether patients with diabetes suffer from a higher case fatality within 90 days after an episode of community-acquired pneumococcal bacteremia compared with pa...

show abstract

“…Infections with influenza carry a high morbidity and mortality rate in patients with diabetes mellitus [1][2][3]. The increased risk of complications in these patients is generally ascribed to the occurrence of diabetic ketoacidosis [4] and secondary bacterial infection, mainly by Staphylococcus aureus [5].…”

mentioning

confidence: 99%

Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Diepersloot

Bouter

Beyer³

et al. 1987

Diabetologia

View full text Add to dashboard Cite

Summary.The antibody response and delayed type hypersensitivity reaction to commercially available trivalent influenza vaccine in 159 patients with diabetes mellitus was compared with response and reaction in 28 healthy volunteers. A correction for prevaccination titres was made. No differences were found between diabetic patients and control subjects with respect to antibody response to the three vaccine strains as measured by the difference between geometric mean titres of post-and prevaccination sera. In Type 1 (insulin-dependent) diabetic patients the incidence of non-responders to two vaccine components was significantly increased (p< 0.05). The delayed type hypersensitivity reaction to influenza antigen was significantly decreased in patients with high concentrations of glycosylated haemoglobin (p<0.01). These findings suggest a role for impaired immune response in the increased influenza morbidity and mortality in patients with diabetes mellitus. Implications for therapy and vaccination strategy are discussed.

show abstract

Diabetic Ketoacidosis During the Influenza Epidemic

Cited by 33 publications

References 13 publications

Influenza immunization; vaccine offer, request and uptake in high-risk patients during the 1991/2 season

Influenza immunization; vaccine offer, request and uptake in high-risk patients during the 1991/2 season

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Contact Info

Product

Resources

About