Influenza Infection and Diabetes Mellitus: Case for Annual Vaccination

Abstract

Herein, epidemiological data on influenza pneumonia and mortality, results of clinical studies, and the outcome of influenza vaccination trials are reviewed. All excess mortality studies that specify for underlying disease list diabetes as one of the major risk factors. During influenza epidemics, death rates among patients with diabetes mellitus may increase by 5-15%. Diabetes mellitus is also mentioned as a risk factor in most clinical studies, making up 3-14% of the patients studied. Even in recent studies, diabetes mellitus is only preceded as a risk factor by cardiovascular disease and chronic pulmonary disorders. To what extent cardiovascular disease and old age contribute to the increased influenza mortality and morbidity in diabetic patients remains unclear. The influence of epidemic influenza on the incidence of diabetic acidosis in combination with an impaired immune response to both Staphylococcus aureus and the influenza virus suggests that diabetes mellitus itself is the main risk factor. It is concluded that all patients with diabetes mellitus should receive annual vaccinations and that, in official recommendations, patients with diabetes mellitus should be mentioned as a separate risk group. Whole-virus vaccines are preferred over subunit vaccines.

Clinical Effectiveness of First and Repeat Influenza Vaccination in Adult and Elderly Diabetic Patients

“…By far, most of the hospitalizations were due to diabetes dysregulation. The fact that, in proportion, diabetes events were most common is not surprising considering the fact that diabetic ketoacidosis is an important complication of influenza infection in patients with diabetes (22). We did not, however, perform virological analysis of our cases to confirm actual influenza infection.…”

Increased Susceptibility of Diabetic Mice to Influenza Virus Infection: Compromise of Collectin-Mediated Host Defense of the Lung by Glucose?

“…Influenza virus infections are associated with higher morbidity and mortality in diabetic patients than in nondiabetic patients (4,6,15). Known risks for diabetic patients with influenza include loss of metabolic control, development of ketoacidosis, and an increased susceptibility to secondary bacterial pneumonia due to diabetes-related immune defects or physiological abnormalities affecting lung function (6,15). Whether diabetes increases susceptibility to influenza virus infection per se is not clear.…”

Prospective application of reverse transcriptase polymerase chain reaction for diagnosing influenza infections in respiratory samples from a children's hospital

“…Influenza viruses are the most important causes of influenza-like illness in the adult, with considerable morbidity and mortality, mainly by secondary bacterial infections. In particular, elderly patients with underlying heart, lung, or immune disease or diabetes are at risk (1,7,(18)(19)(20).…”