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Influenza-Focus on Diabetic Patients

People with diabetes are more susceptible to infection

Key mechanisms associated with infection risk in diabetes:1

Figure adapted from Casqueiro J, et al. 2012.1

Abbreviation

GIT, gastrointestinal tract; PMN, polymorphonuclear leukocyte.

People with diabetes experience more serious outcomes following influenza infection

  • 3-6x risk of hospitalization2,4*
  • 4x risk of ICU admission following hospitalization2*
  • 4x risk of death from pneumonia3*
  • 6x risk of death5*

Abbreviation

ICU, intensive care unit

Influenza vaccination was associated with hospitalization rates reduction for CV outcomes in people with type 2 diabetes6

Retrospective cohort analysis of the effectiveness of influenza vaccination in people with type 2 diabetes in England over a 7 year period (N=124,503).

  • 22% hospitalization for heart failure (IRR 0.78, 95% CI 0.65–0.92)*1
  • 30% hospitalization for stroke (IRR 0.70, 95% CI 0.53–0.91)*1
  • 19% hospitalization for acute MI (IRR 0.81, 95% CI 0.62–1.04)*1

 

†Retrospective cohort analysis of the effectiveness of influenza vaccination in people with T2DM in England over a 7 year period (N=124,503).1 *vs unvaccinated people with diabetes.

Abbreviation

CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; HR, hazard ratio; IRR, incidence rate ratio; MI, myocardial infarction; T2DM,

Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with all Types of Diabetes

Danish nationwide cohort study in 241,551 patients, during 9 consecutive influenza seasons (2007-2016)7

Forest plot of the association between influenza vaccination and risk of death when considering all seasons included in the study. The error bars represent 95% CIs. HRs were derived from multivariable Cox regression models with patient-level cluster variances and stratified on season year.

“Influenza vaccination is significantly associated with reduced risks of all-cause, cardiovascular, and stroke/AMI death despite rigorous control for confounding factors”

  • 22% hospitalization for heart failure (IRR 0.78, 95% CI 0.65–0.92)*1
  • 30% hospitalization for stroke (IRR 0.70, 95% CI 0.53–0.91)*1
  • 19% hospitalization for acute MI (IRR 0.81, 95% CI 0.62–1.04)*1

†Retrospective cohort analysis of the effectiveness of influenza vaccination in people with T2DM in England over a 7 year period (N=124,503).1 *vs unvaccinated people with diabetes.

Abbreviation

CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; HR, hazard ratio; IRR, incidence rate ratio; MI, myocardial infarction; T2DM,

Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with all Types of Diabetes

Danish nationwide cohort study in 241,551 patients, during 9 consecutive influenza seasons (2007-2016)7

Forest plot of the association between influenza vaccination and risk of death when considering all seasons included in the study. The error bars represent 95% CIs. HRs were derived from multivariable Cox regression models with patient-level cluster variances and stratified on season year.

“Influenza vaccination is significantly associated with reduced risks of all-cause, cardiovascular, and stroke/AMI death despite rigorous control for confounding factors”

  • 17% of all-cause death
  • 16% of cardiovascular death
  • 15% of death from AMI or stroke
  • 11% of being admitted to hospital with acute complications associated with diabetes*

*diabetic ketoacidosis, hypoglycemia, or coma

Influenza vaccination in diabetes is a well-established recommendation8-10

Annual influenza vaccination is recommended for people with diabetes by health authorities and associations worldwide8

The WHO recommends increasing influenza coverage of all people at high risk (including persons with diabetes)8

Abbreviation

WHO, World Health Organization.

Influenza vaccination rates remain sub-optimal worldwide11-15

In most countries there are no data on vaccine coverage rate for people with diabetes

  • Diabetes is on therise and globally 1 in 11 adults has diabetes16
  • Datashow that influenzais an aggravating factor for diabetes people
  • Influenza vaccination was associated witha reduction in the rate of hospital admissionsand deaths19,21
  • Influenza vaccination is recommended(and funded) for people withdiabetes

Despite these risks, influenza vaccines are underutilized in populations with diabetes20

  • 3 times more risk ofhospitalizations17
  • 6 times more risk ofdeaths18 
    compared to non-diabetics population
  • 30% for stroke19
  • 22% for heart failure19
  • 15% for pneumonia/influenza19
  • 15%for cardiovascular deaths 21 
  • Up to 24% on all-cause death 19, 21

References

  1. Casqueiro J, et al. Indian J Endocrinol Metab. 2012.
  2. Allard R, et al. Diabetes Care. 2010; 33:1491–3.
  3. Valdez R, et al. Am J Public Health. 1999; 89: 1715–21.
  4. BouterKP, Diabetes Res Clin Pract1991;12:61-8.
  5. https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19(p4)accessed date December 2019
  6. VamosEP, et al. Can Med Assoc J. 2016; 188: E342–51
  7. Modinet al. DiabetesCare. 2020 Sep;43(9):2226-2233
  8. http://www.who.int/wer/2012/wer8747.pdf?ua=1
  9. https://idf.org/our-network/regions-members/europe/europe-news/290-people-living-with-diabetes-should-be-prioritised-for-a-covid-19-vaccine.html
  10. https://www.ecdc.europa.eu/sites/default/files/documents/seasonal-influenza-antiviral-use-2018.pdf
  11. Hung et al , Vaccine.2020 Sep 29;38(42):6545-655
  12. Tacken, Vaccine 2015; 33(38):4886-91.
  13. O'Halloran, Am 3. J PrevMed 2016; 50(1):e15-26.
  14. Yang, Infect Chemother 2015; 47(1):41-8.
  15. Yu, Hum VaccinImmunother2014; 10(4):1028-35
  16. International Diabetes Federation.IDF Diabetes Atlas, 9th edn.Brussels, Belgium: 2019. Available at:http://www.diabetesatlas.org
  17. Allard R, et al. Diabetes Care. 2010; 33:1491–
  18. https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19(p4)accessed date December 2019.
  19. VamosEP, et al. Can Med Assoc J. 2016; 188: E342–51.
  20. NFID,Call to Action: The Dangers of Influenza and Benefits of Vaccination in Adults with Chronic Health Conditions. 2018.
  21. Modinet al. Diabetes Care. 2020 Sep;43(9):2226-2233
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