Epidemiology and costs of severe acute respiratory infection and influenza hospitalizations in adults with diabetes in India

Abstract

Introduction: The incidence of diabetes mellitus is increasing rapidly in India. In addition to well-known complications, diabetes increases the risk for hospitalization and death from severe acute respiratory infection (SARI) and influenza. Here we examined the impact of SARI and influenza in Indian adults with diabetes.
 Methodology: This was a single-center, active surveillance study conducted in Jammu and Kashmir State, India, during the 2015–2016 and 2016–2017 influenza seasons. Adults hospitalized for SARI and receiving at least one diabetes medication were included. Demographics, health care use, and direct costs were collected from medical records and interviews of patients or caregivers. Indirect costs were estimated based on lost earnings and WHO-CHOICE estimates for hospital costs.
 Results: The study included 192 patients with type 2 diabetes. Median age was 66 years, median body mass index was 26.6 kg/m2, and most patients had comorbidities, especially hypertension and cardiovascular disease (83.9%). Only 32.2% regularly monitored blood glucose or hemoglobin A1C, and median values at admission indicated poor glycemic control for most. Influenza was detected in 8.9% of cases. The median hospital stay for SARI was 8 days, and 22 patients (11.4%) died. Median total costs associated with hospitalization were US$710 (interquartile range, $539–$1067) for SARI patients and US$716 ($556–$1078) for influenza patients, mostly (~75%) from indirect costs.
 Conclusions: Adults with diabetes in India hospitalized with SARI or influenza are generally older, in poor health, and suffer from poor glycemic control. The costs for their hospitalization and care are substantial.

Survival in influenza virus-related pneumonia by viral subtype: 2016-2020

“…Type 2 diabetes mellitus, which is highly prevalent in Mexican adults, is related to the increased severity of influenza infections (Koul et al 2019). Diabetic subjects from our study had a 37% increase in the risk of dying (HR= 1.37, 95% CI 1.19-1.59) when compared with non-diabetic patients.…”

Effectiveness of a nurse‐led mindfulness stress‐reduction intervention on diabetes distress, diabetes self‐management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial

“…Thus, we need to better understand which stage of intervention maintenance delivery of nurse‐led MBSR therapy is the most effective and what happens if there is no maintenance intervention in the future study. Third, in countries with longer hospital stays for diabetes treatment, not only in China but in many other countries, such as Australia, Brazil, and India (Karahalios et al, 2018; Koul et al, 2019; Rodrigues et al, 2017; Wu et al, 2020), a nurse‐led MBSR therapy could be considered. Other formats of a nurse‐led MBSR therapy should be considered for settings with a shorter hospital length of stay, such as using telehealth or providing the program in work settings.…”

“…The ability of our study to describe the causal mechanism to the content and method of delivery of the intervention group is limited. Koul et al, 2019;Rodrigues et al, 2017;Wu et al, 2020), a nurse-led MBSR therapy could be considered. Other formats of a nurse-led MBSR therapy should be considered for settings with a shorter hospital length of stay, such as using telehealth or providing the program in work settings.…”

High-resolution computed tomography enhances the diagnosis and follow-up of influenza A (H1N1) virus-associated pneumonia

“…This observation led us to conclude that many requests for chest X-ray should have been replaced by requests for HRCT because of its higher ability to display the lesions, thus allowing immediate and appropriate treatment with antivirals. Treatment of patients with influenza incurs a high cost, particularly when there are associated comorbidities [10], and the indication of CT examination can help reduce it.…”