Oseltamivir and the risk of influenza-related complications and hospitalizations in patients with diabetes

      This paper is only available as a PDF. To read, Please Download here.


      Objective: This subgroup analysis of a retrospective cohort study examined, from a managed care perspective, the risk of influenza-related complications and hospitalizations in patients with diabetes who were prescribed oseltamivir for the treatment of influenza and those who were not prescribed antiviral treatment.
      Methods: Health insurance claims data from the Thomson Healthcare MarketScan Research Database for 6 influenza seasons (October 1-March 31) between 2000 and 2006 were used to identify patients aged ≥18 years with influenza and diabetes. Patients who received a prescription for oseltamivir within 1 day of a diagnosis of influenza were compared with those who received no antiviral treatment. Outcomes included the frequency of pneumonia, respiratory diagnoses, and otitis media and its complications, and rates of hospitalization within 14 days of the diagnosis of influenza. Cox proportional hazards regression was used to determine the relative risk (RR) of influenza-related complications and hospitalizations.
      Results: A total of 9090 patients with diabetes and a diagnosis of influenza were identified who met all study criteria. Of these, 2919 (32%) received a prescription for oseltamivir and 6171 (68%) received no antiviral treatment. Patients receiving oseltamivir had a significant 17% reduction in the risk of respiratory illnesses (RR = 0.83; 95% CI, 0.73-0.93) and a 30% reduction in the risk of hospitalization for any reason (RR = 0.70; 95% CI, 0.52-0.94). There were no significant differences between the oseltamivir and control groups in terms of the risks for pneumonia (RR = 0.87; 95% CI, 0.64-1.18), otitis media and its complications (RR = 0.96; 95% CI, 0.48-1.91), or hospitalization for pneumonia (RR = 0.81; 95% CI, 0.41-1.58).
      Conclusion: In this retrospective study, the risk of influenza-associated respiratory illnesses and the number of hospitalizations for any reason were reduced in patients with diabetes who were prescribed oseltamivir compared with an unmatched group that was not prescribed antiviral therapy.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Thompson WW
        • Shay DK
        • Weintraub E
        • et al.
        Influenza associated hospitalizations in the United States.
        JAMA. 2004; 292: 1333-1340
        • Thompson WW
        • Shay DK
        • Weintraub E
        • et al.
        Mortality associated with influenza and respiratory syncytial virus in the United States.
        JAMA. 2003; 289: 179-186
        • Smith NM
        • Bresee JS
        • Shay DK
        • et al.
        • for the Advisory Committee on Immunization Practices
        Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) [published correction appears in MMWR Recomm Rep. 2006;55:800].
        MMWR Recomm Rep. 2006; 55: 1-42
        • Eickhoff TC
        • Sherman IL
        • Serfling RE
        Observations on excess mortality associated with epidemic influenza.
        JAMA. 1961; 176: 776-782
        • Housworth J
        • Langmuir AD
        Excess mortality from epidemic influenza, 1957-1966.
        Am J Epidemiol. 1974; 100: 40-48
        • Wong CM
        • Yang L
        • Chan KP
        • et al.
        Influenza-associated hospitalization in a subtropical city.
        PLoS Med. 2006; 3: e121
        • Bouter KP
        • Diepersloot RJ
        • van Romunde LK
        • et al.
        Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: A hospital register survey of 1976-1979 in The Netherlands.
        Diabetes Res Clin Pract. 1991; 12: 61-68
        • Diepersloot RJ
        • Bouter KP
        • Hoekstra JB
        Influenza infection and diabetes mellitus. Case for annual vaccination.
        Diabetes Care. 1990; 13: 876-882
        • Muller LM
        • Gorter KJ
        • Hak E
        • et al.
        Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus.
        Clin Infect Dis. 2005; 41: 281-288
        • Bont J
        • Hak E
        • Hoes AW
        • et al.
        A prediction rule for elder primary-care patients with lower respiratory tract infections.
        Eur Respir J. 2007; 29: 969-975
        • Chandler PT
        • Chandler SD
        Pathogenic carrier rate in diabetes mellitus.
        Am J Med Sci. 1977; 273: 259-265
        • Lipsky BA
        • Pecoraro RE
        • Chen MS
        • Koepsell TD
        Factors affecting staphylococcal colonization among NIDDM outpatients.
        Diabetes Care. 1987; 10: 483-486
        • Koziel H
        • Koziel MJ
        Pulmonary complications of diabetes mellitus. Pneumonia.
        Infect Dis Clin North Am. 1995; 9: 65-96
        • Smith SA
        • Poland GA
        Use of influenza and pneumococcal vaccines in people with diabetes.
        Diabetes Care. 2000; 23: 95-108
        • Goslings WR
        • Mulder J
        • Djajadiningrat J
        • Masurel N
        Staphylococcal pneumonia in influenza in relation to antecedent staphylococcal skin infection.
        Lancet. 1959; 2: 428-430
        • Standards of medical care in diabetes-2007
        Diabetes Care. 2007; 30: S4-S41
        • From the Centers for Disease Control and Prevention
        Influenza and pneumococcal vaccination rates among persons with diabetes mellitus-United States, 1997.
        JAMA. 2000; 283: 48-50
        • Egede LE
        Association between number of physician visits and influenza vaccination coverage among diabetic adults with access to care.
        Diabetes Care. 2003; 26: 2562-2567
      1. Influenza and pneumococcal vaccination coverage among persons aged ≥65 years and persons aged 18–64 years with diabetes or asthma–United States, 2003.
        MMWR Morb Mortal Wkly Rep. 2004; 53: 1007-1012
        • Ross JS
        • Bradley EH
        • Busch SH
        Use of health care services by lower-income and higher-income uninsured adults.
        JAMA. 2006; 295: 2027-2036
        • Jefferson T
        • Demicheli V
        • Rivetti D
        • et al.
        Antivirals for influenza in healthy adults: Systematic review.
        Lancet. 2006; 367 ([published correction appears in Lancet. 2006;367:2060]): 303-313
        • Treanor JJ
        • Hayden FG
        • Vrooman PS
        • et al.
        • for the US Oral Neuraminidase Study Group
        Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: A randomized controlled trial.
        JAMA. 2000; 283: 1016-1024
        • Cooper NJ
        • Sutton AJ
        • Abrams KR
        • et al.
        Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: Systematic review and meta-analyses of randomised controlled trials.
        BMJ. 2003; 326: 1235
        • Hayden FG
        • Treanor JJ
        • Fritz RS
        • et al.
        Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: Randomized controlled trials for prevention and treatment.
        JAMA. 1999; 282: 1240-1246
        • Nordstrom BL
        • Sung I
        • Suter P
        • Szneke P
        Risk of pneumonia and other complications of influenzalike illness in patients treated with oseltamivir.
        Curr Med Res Opin. 2005; 21: 761-768
        • Kaiser L
        • Wat C
        • Mills T
        • et al.
        Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations.
        Arch Intern Med. 2003; 163: 1667-1672
        • Barr CE
        • Schulman K
        • Iacuzio D
        • Bradley JS
        Effect of oseltamivir on the risk of pneumonia and use of health care services in children with clinically diagnosed influenza.
        Curr Med Res Opin. 2007; 23: 523-531
        • Bridges CB
        • Thompson WW
        • Meltzer MI
        • et al.
        Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial.
        JAMA. 2000; 284: 1655-1663
      2. Consumer price indexes [Bureau of Labor Statistics Web site]

      3. (Available at:) (Accessed January 30, 2007)
        • Looijmans-Van den Akker I
        • Verheij TJ
        • Buskens E
        • et al.
        Clinical effectiveness of first and repeat influenza vaccination in adult and elderly diabetic patients.
        Diabetes Care. 2006; 29: 1771-1776
        • Vindt Holm M
        • Gyldmark M
        • Holme Hansen E
        Pharmacoeconomic assessment of oseltamivir in treating influenza-the case of otherwise healthy Danish adolescents and adults.
        Pharm World Sci. 2004; 26: 339-345
        • Lee PY
        • Matchar DB
        • Clements DA
        • et al.
        Economic analysis of influenza vaccination and antiviral treatment for healthy working adults.
        Ann Intern Med. 2002; 137: 225-231
        • Szucs T
        The socio-economic burden of influenza.
        J Antimicrob Chemother. 1999; 44: 11-15
        • Kaye WA
        • Adri MN
        • Soeldner JS
        • et al.
        Acquired defect in interleukin-2 production in patients with type I diabetes mellitus.
        N Engl J Med. 1986; 315: 920-924
        • Katz S
        • Klein B
        • Elian I
        • et al.
        Phagocytotic activity of monocytes from diabetic patients.
        Diabetes Care. 1983; 6: 479-482
        • Colquhoun AJ
        • Nicholson KG
        • Botha JL
        • Raymond NT
        Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes.
        Epidemiol Infect. 1997; 119: 335-341
      4. IMS Health National Sales Perspectives (September 2006-May 2007). Fairfield, Conn: IMS Health; 2007.

      5. Tamiflu. Roche Laboratories, Nutley, NJ2006 ([package insert])