Prevalence of Diabetes in the 2009 Influenza A (H1N1) and the Middle East Respiratory Syndrome Coronavirus: A Systematic Review and Meta-Analysis

Abstract

Over the past two decades a number of severe acute respiratory infection outbreaks such as the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have emerged and presented a considerable global public health threat. Epidemiologic evidence suggests that diabetic subjects are more susceptible to these conditions. However, the prevalence of diabetes in H1N1 and MERS-CoV has not been systematically described. The aim of this study is to conduct a systematic review and meta-analysis of published reports documenting the prevalence of diabetes in H1N1 and MERS-CoV and compare its frequency in the two viral conditions. Meta-analysis for the proportions of subjects with diabetes was carried out in 29 studies for H1N1 ( n=92,948) and 9 for MERS-CoV ( n=308). Average age of H1N1 patients (36.2±6.0 years) was significantly younger than that of subjects with MERS-CoV (54.3±7.4 years, P<0.05). Compared to MERS-CoV patients, subjects with H1N1 exhibited 3-fold lower frequency of cardiovascular diseases and 2- and 4-fold higher prevalence of obesity and immunosuppression, respectively. The overall prevalence of diabetes in H1N1 was 14.6% (95% CI: 12.3-17.0%; P<0.001), a 3.6-fold lower than in MERS-CoV (54.4%; 95% CI: 29.4-79.5; P<0.001). The prevalence of diabetes among H1N1 cases from Asia and North America was ~two-fold higher than those from South America and Europe. The prevalence of diabetes in MERS-CoV cases is higher than in H1N1. Regional comparisons suggest that an etiologic role of diabetes in MERS-CoV may exist distinctive from that in H1N1.

Significance for public health

Outbreaks of the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have presented a considerable global public health threat over the past few years. Evidence suggest that infected subjects who are also diabetic are more likely to be susceptible to severe outcome of H1N1 and MERS-CoV. Systematic analysis of ~93,000 H1N1 cases and ~300 MERS-CoV cases indicated an overall prevalence of 14.6% and 54.4% for diabetes in H1N1 and MERS-CoV cases, respectively. This may suggest a possible etiological relationship between diabetes and each of the two infectious conditions. Introduction of effective public health vaccination intervention strategies against severe acute respiratory infections should be developed to target subjects with chronic disorders such as diabetes, obesity and cardiovascular conditions.