Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain

Objectives To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory-confirmed A(H1N1)pdm09 infections in Spain during 2009. Methods Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD-9-CM code 488 center dot 1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in-hospital case fatality risk, length of hospital stay, and costs. Results The total number of persons hospitalized with A(H1N1)pdm09 was 11499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26 center dot 8%), and for Type 1 renal disease (10 center dot 3%). In-hospital mortality was 2 center dot 1% among Type 1 patients, 3 center dot 8% among Type 2 patients, and 2 center dot 3% among non-diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1 center dot 03; 95% CI1 center dot 011 center dot 05), hematological disorders (OR 3 center dot 49; 95% CI, 1 center dot 468 center dot 37), and obesity (OR 1 center dot 88; 95% CI1 center dot 073 center dot 92). Conclusions Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age-specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.