Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies

Dicembrini, Ilaria; Silverii, Giovanni Antonio; Clerico, Alessandra; Fornengo, R.; Gabutti, Giovanni; Sordi, Valeria; Tafuri, Silvio; Peruzzi, Ottavia; Mannucci, Edoardo

doi:10.1016/j.numecd.2023.03.016

Cited by 19 publications

(9 citation statements)

References 52 publications

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“…Among the more frequent chronic diseases, Diabetes Mellitus (DM) has been associated with a 14-32% higher possibility of a severe course of disease [5] and a higher mortality for Coronavirus disease-19 (COVID-19), both in hospitalized patients [6] and in the general population [7], especially in those with a longer disease duration [8]. This finding is in line with previous observations which established DM as a risk factor for a more severe course of several infectious illnesses [9], including a higher risk for influenza-related hospitalization and death [10] and a higher risk for mortality for other diseases caused by coronaviruses, such as Severe Acute Respiratory Syndrome (SARS-CoV-1) [11], or Middle East Respiratory Syndrome Coronavirus (MERS-CoV) [12]. Furthermore, the hesitancy toward the COVID-19 vaccine is not negligible in people with DM, especially in those with further risk factors such as worse glycemic control and obesity [13], potentially increasing the harmful potential of COVID-19 in people with Diabetes Mellitus [14].…”

Section: Introductionsupporting

confidence: 86%

Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

Silverii,

Fumagalli,

Rozzini

et al. 2024

JCM

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Background: Diabetes Mellitus (DM) has been associated with a higher Coronavirus disease-19 (COVID-19) mortality, both in hospitalized patients and in the general population. A possible beneficial effect of metformin on the prognosis of COVID-19 has been reported in some observational studies, whereas other studies disagree. Methods: To investigate the possible effect of metformin on COVID-19 in-hospital mortality, we performed a retrospective study that included all SARS-CoV-2-positive patients with DM who were admitted to two Italian hospitals. In order to adjust for possible confounders accounting for the observed reduction of mortality in metformin users, we adopted the COVID-19 Mortality Risk Score (COVID-19 MRS) as a covariate. Results: Out of the 524 included patients, 33.4% died. A binomial logistic regression showed that metformin use was associated with a significant reduction in case fatality (OR 0.67 [0.45–0.98], p = 0.039), with no significant effect on the need for ventilation (OR 0.75 [0.5–1.11], p = 0.146). After adjusting for COVID-19 MRS, metformin did not retain a significant association with in-hospital mortality [OR 0.795 (0.495–1.277), p = 0.342]. Conclusions: A beneficial effect of metformin on COVID-19 was not proven after adjusting for confounding factors. The use of validated tools to stratify the risk for COVID-19 severe disease and death, such as COVID-19 MRS, may be useful to better explore the potential association of medications and comorbidities with COVID-19 prognosis.

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Section: Introductionsupporting

confidence: 86%

Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

Silverii,

Fumagalli,

Rozzini

et al. 2024

JCM

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“…The absence of any association with diabetes is currently unexplained, but it could be related to a higher vaccination rate, as discussed elsewhere ( 30 ). As for organ transplantation, this variable may have low prevalence in the overall cohort, leaving the analysis underpowered.…”

Section: Discussionmentioning

confidence: 89%

Impact of influenza related hospitalization in Spain: characteristics and risk factor of mortality during five influenza seasons (2016 to 2021)

Ramos-Rincón,

Pinargote-Celorio,

González-de-la-Aleja

et al. 2024

Front. Public Health

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BackgroundEstimating the global influenza burden in terms of hospitalization and death is important for optimizing prevention policies. Identifying risk factors for mortality allows for the design of strategies tailored to groups at the highest risk. This study aims to (a) describe the clinical characteristics of hospitalizations with a diagnosis of influenza over five flu seasons (2016–2017 to 2020–2021), (b) assess the associated morbidity (hospitalization rates and ICU admissions rate), mortality and cost of influenza hospitalizations in different age groups and (c) analyze the risk factors for mortality.MethodsThis retrospective study included all hospital admissions with a diagnosis of influenza in Spain for five influenza seasons. Data were extracted from the Spanish National Surveillance System for Hospital Data from 1 July 2016 to 30 June 2021. We identified cases coded as having influenza as a primary or secondary diagnosis (International Classification of Diseases, 10th revision, J09-J11). The hospitalization rate was calculated relative to the general population. Independent predictors of mortality were identified using multivariable logistic regression.ResultsOver the five seasons, there were 127,160 hospitalizations with a diagnosis of influenza. The mean influenza hospitalization rate varied from 5/100,000 in 2020–2021 (COVID-19 pandemic) to 92.9/100,000 in 2017–2018. The proportion of influenza hospitalizations with ICU admission was 7.4% and was highest in people aged 40–59 years (13.9%). The case fatality rate was 5.8% overall and 9.4% in those aged 80 years or older. Median length of stay was 5 days (and 6 days in the oldest age group). In the multivariable analysis, independent risk factors for mortality were male sex (odds ratio [OR] 1.14, 95% confidence interval [95% CI] 1.08–1.20), age (<5 years: OR 1; 5–19 years: OR 2.02, 95%CI 1.17–3.49; 20–39 years: OR 4.11, 95% CI 2.67–6.32; 40–59 years: OR 8.15, 95% CI 5.60–11.87; 60–79 years: OR 15.10, 95% CI 10.44–21.84; ≥80 years: OR 33.41, 95% CI 23.10–48.34), neurological disorder (OR 1.97, 95% CI 1.83–2.11), heart failure (OR 1.85, 95% CI 1.74–1.96), chronic kidney disease (OR 1.33, 95% CI 1.25–1.41), chronic liver disease (OR 2.95, 95% CI 2.68–3.27), cancer (OR 1.85, 95% CI 1.48–2.24), coinfection with SARS-CoV2 (OR 3.17, 95% CI 2.34–4.28), influenza pneumonia (OR 1.76, 95% CI 1.66–1.86) and admission to intensive care (OR 7.81, 95% CI 7.31–8.36).ConclusionInfluenza entails a major public health burden. People aged over 60—and especially those over 80—show the longest hospital stays. Age is also the most significant risk factor for mortality, along with certain associated comorbidities.

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“…Annually, influenza is responsible for approximately 10000 to 30000 fatalities, and individuals with DM have a sixfold increased likelihood of hospitalization during an outbreak compared to those without DM[ 8 ]. Through extensive efforts to promote vaccination within this vulnerable population, which have shown promising results, a study indicated that the influenza vaccine effectively reduced rates of hospitalization and mortality, with a number needed to treat of 60, 319, and 250 for all-cause hospitalizations, specific hospitalization, and all-cause mortality, respectively[ 10 ]. Another study demonstrated a decline in the risk of invasive pneumococcal disease (adjusted odds ratio = 0.86, 95% confidence interval: 0.78-0.94) among vaccinated patients compared to unvaccinated patients, along with a shorter length of stay at the hospital (-1.27 ± 0.19 d, P = 0.0012)[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia: A multicenter retrospective study

Alqifari,

Esmail,

Alarifi

et al. 2024

World J Diabetes

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BACKGROUND Patients with diabetes mellitus (DM) are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications. The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) issued immunization re-commendations to protect this patient population. AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate. METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey. RESULTS Among participants, 10.01% (n = 71) had never received any vaccine, while 85.89% (n = 609) received at least one dose of the coronavirus disease 2019 (COVID-19) vaccine, and 34.83% (n = 247) had received the annual influenza vaccine. Only 2.96% (n = 21), 2.11% (n = 15), and 1.12% (n = 8) received herpes zoster, tetanus, diphtheria, and pertussis (Tdap), and human papillomavirus (HPV) vaccines, respectively. For patients with DM in Saudi Arabia, the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, site of care, income level, DM-related hospitalization history, residency site, hemoglobin A1c (HbA1c) level, and health sector type can significantly influence the vaccination rate in patients with DM. Among non-vaccinated patients with DM, the most reported barriers were lack of knowledge and fear of side effects. This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM. CONCLUSION In Saudi Arabia, patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, the site of care, income level, DM-related hospitalization history, residency site, HbA1c level, and health sector type can significantly influence the vaccination rate in patients with DM.

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Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies

Cited by 19 publications

References 52 publications

Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

Impact of influenza related hospitalization in Spain: characteristics and risk factor of mortality during five influenza seasons (2016 to 2021)

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia: A multicenter retrospective study

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