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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Rates and associates of influenza and pneumococcus vaccination in diabetes mellitus: A nationwide cross-sectional study (TEMD vaccination study)
Ibrahim Demirci, Cem Haymana, Serpil Salman, Ilker Tasci, Demet Corapcioglu, Ali Kirik, İlhan Yetkin, Mustafa Altay, Tevfik Sabuncu, Fahri Bayram, Ilhan Satman, Alper Sonmez, TEMD Study Group
Ibrahim Demirci, Cem Haymana, Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, Ankara 06190, Turkey
Serpil Salman, Department of Endocrinology and Metabolism, Liv Hospital, Istanbul 34000, Turkey
Ilker Tasci, Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara 06018, Turkey
Demet Corapcioglu, Department of Endocrinology and Metabolism, Ankara University, Faculty of Medicine, Ankara 06560, Turkey
Ali Kirik, Department of Internal Medicine, Balıkesir University, Faculty of Medicine, Balikesir 10145, Turkey
İlhan Yetkin, Department of Endocrinology and Metabolism, Gazi University, Faculty of Medicine, Ankara 06190, Turkey
Mustafa Altay, Department of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Ankara 06190, Turkey
Tevfik Sabuncu, Department of Endocrinology and Metabolism, Harran University, Faculty of Medicine, Sanliurfa 63050, Turkey
Fahri Bayram, Department of Endocrinology and Metabolism, Erciyes University, Faculty of Medicine, Kayseri 38000, Turkey
Ilhan Satman, Department of Endocrinology and Metabolism, Istanbul University, Faculty of Medicine, Istanbul 34000, Turkey
Alper Sonmez, Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Faculty of Medicine, Ankara 06190, Turkey
Author contributions: Demirci I and Haymana C collected data, performed the analyses and wrote the draft; Salman S, Corapcioglu D, Kirik A and Yetkin İ designed the research; Tasci I supervised the statistical analyses; Sabuncu T and Bayram F revised the manuscript; Altay M, Satman I and Sonmez A performed the research and wrote the paper; all TEMD Study Group members contributed to the database and re-check the manuscript and collaborators of the TEMD Obesity Study Group are listed in the online Supplementary material.
Institutional review board statement: The study was reviewed and approved by the TC Sağlık Bakanlığı Türkiye İlaç ve Tıbbi Cihaz Kurumu Institutional Review Board 93189304-514.11.01 E.58933.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mustafa Altay, MD, Chairman, Professor, Department of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Yeşilevler mahallesi, 926. cadde, Markaevleri 2 sitesi C/14, Yenimahalle, Ankara 06190, Turkey. mustafa.altay@sbu.edu.tr
Received: May 12, 2021
Peer-review started: May 12, 2021
First decision: July 4, 2021
Revised: July 13, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: December 15, 2021
ARTICLE HIGHLIGHTS
Research background
The prevalence of diabetes is increasing worldwide, and increased diabetes frequency means an increase in the incidence of diabetes-related mortality and morbidity. Turkey stands as the country with the highest diabetes mellitus prevalence in Europe. Since commonly seen infections are associated with significantly increased morbidity and mortality, vaccination programs are now among the standard of care for diabetes mellitus. Vaccination for influenza and pneumococcal infections has gained broad acceptance worldwide.
Research motivation
Although current guidelines emphasize the importance of influenza and pneumococcal vaccination in diabetic patients and that physician acceptance has been reported to increase, the reported vaccination rates still remain low in many countries with different economic development. The rates of vaccination in patients with diabetes mellitus in Turkey have not been systematically evaluated so far.
Research objectives
The main objective of the current study was to perform a nationwide survey to explore the vaccination status for two major diseases, pneumococcus and influenza, among patients with diabetes mellitus. The secondary objective was to determine which patients tend to get vaccinated or not vaccinated.
Research methods
In a multicenter, cross-sectional survey design, the TEMD Vaccination Study enrolled 454 patients with type 1 diabetes mellitus (T1DM) and 4721 patients with type 2 diabetes mellitus (T2DM), who were under followed up in 68 tertiary endocrinology clinics. Vaccination status was assessed by self-reports and medical records.
Research results
The study found 23.6% and 8% vaccination rates for influenza and pneumococcus, respectively, in patients with T1DM. The rates were 21.2% and 8% in patients with T2DM. Vaccination for both conditions was recorded in 6.6% of patients with T1DM and 5.8% of patients with T2DM. Older age and longer diabetes duration were the most common associates of vaccination for both types of diabetes. Among patients with T2DM, higher education level, statin use, and lower HbA1c level were also independently associated with higher vaccination status.
Research conclusions
This study showed for the first time that patients with T1DM and T2DM had very low influenza and pneumococcal vaccination rates in Turkey. The findings warrant new and improved strategies to increase the awareness of vaccination among the partners involved in different levels of diabetes care, from patients to policymakers and healthcare professionals.
Research perspectives
As vaccination programs are cost-saving by reducing diabetes-related mortality and morbidity, there is an unmet need to identify the barriers and obstacles against the acceptance of vaccination programs by the patients and healthcare programs in this population. Additionally, potential difficulties in implementing the vaccination programs at the system level need to be identified. Finally, increasing the number of patients with diabetes mellitus who are vaccinated should be prioritized as these patients are considered much defenseless against opportunistic infections.
