Impact of diabetes on dengue – a comparative study of clinical and inflammatory variables in patients with and without diabetes
DOI:
https://doi.org/10.15584/ejcem.2025.3.28Keywords:
C-reactive protein, dengue and diabetes, dengue fever, ferritin, interleukin 6, triglycerideAbstract
Introduction and aim. Dengue fever is a mosquito-borne viral disease and its severity may be influenced by comorbid conditions such as diabetes mellitus, which can alter the inflammatory and clinical response. This study aimed to evaluate and compare clinical characteristics, laboratory findings, and inflammatory markers between patients with and without diabetes who were diagnosed with dengue infection.
Material and methods. The retrospective observational study included 100 patients with confirmed dengue infection, divided equally into 50 with diabetes and 50 without. It examined the distribution of age, HbA1C levels, clinical symptoms, bleeding events, liver enzymes, and inflammatory markers. Correlation analyzes were conducted to assess the relationship between HbA1C levels and inflammatory markers within each group. In addition, inflammatory markers were compared in different age categories (<50 years and ≥50 years) and by diabetic status.
Results. Laboratory findings, including liver enzymes and inflammatory markers, were markedly elevated in the diabetic cohort (p<0.001). The correlation analysis revealed a strong positive relationship between HbA1c and inflammatory markers in the diabetic group (r>0.8, p<0.001), while weaker correlations were observed in the non-diabetic group (r=0.4–0.6, p<0.001). Inflammatory markers were significantly higher in diabetic patients, particularly those 50 and older.
Conclusion. Diabetes may contribute to a more intense inflammatory response in dengue, highlighting it as an independent risk factor for severe clinical outcomes in dengue infection.
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References
World Health Organization. Dengue vaccine: WHO position paper, September 2018 - Recommendations. Vaccine. 2019;37(35):4848-4849. doi: 10.1016/j.vaccine.2018.09.063
Ogunlade ST, Meehan MT, Adekunle AI, Rojas DP, Adegboye OA, McBryde ES. A Review: Aedes-Borne Arboviral Infections, Controls and Wolbachia-Based Strategies. Vaccines (Basel). 2021;9(1):32. doi: 10.3390/vaccines9010032
Gould E, Pettersson J, Higgs S, Charrel R, De Lamballerie X. Emerging arboviruses: why today? One Health. 2017;4:1-3. doi: 10.1016/j.onehlt.2017.06.001.
Buhler C, Winkler V, Runge-Ranzinger S, Boyce R, Horstick O. Environmental methods for dengue vector control–A systematic review and meta-analysis. PLoS Negl Trop Dis. 2019;13(7):e0007420. doi: 10.1371/journal.pntd.0007420
Blagrove MS, Arias-Goeta C, Failloux AB, Sinkins SP. Wolbachia strain wMel induces cytoplasmic incompatibility and blocks dengue transmission in Aedes albopictus. Proc Natl Acad Sci USA. 2012;109(1):255-260. doi: 10.1073/pnas.1112021108
Joubert DA, Walker T, Carrington LB, et al. Establishment of a Wolbachia superinfection in Aedes aegypti mosquitoes as a potential approach for future resistance management. PLoS Pathog. 2016;12(2):e1005434. doi: 10.1371/journal.ppat.1005434
Htun NS, Odermatt P, Eze IC, Boillat-Blanco N, D’Acremont V, Probst-Hensch N. Is diabetes a risk factor for a severe clinical presentation of dengue?-Review and meta-analysis. PLoS Negl Trop Dis. 2015;9(4):e0003741. Doi: 10.1371/journal.pntd.0003741
Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412. doi: 10.1136/bmj.321.7258.405
Pan American Health Organization (PAHO). Guidelines for the Clinical Diagnosis and Treatment of Dengue, Chikungunya, and Zika. Washington, DC: Pan American Health Organization; 2022. doi:10.37774/9789275124871
Limonta D, Torres G, Capó V, Guzmán MG. Apoptosis, vascular leakage, and increased risk of severe dengue in a type 2 diabetes mellitus patient. Diabetes Vasc Dis Res. 2008;5(3):213-214. doi: 10.3132/dvdr.2008.034
Lee K, Hsieh CJ, Lee CT, Liu JW. Diabetic patients suffering dengue are at risk for development of dengue shock syndrome/severe dengue: Emphasizing the impacts of co-existing comorbidity(ies) and glycemic control on dengue severity. J Microbiol Immunol Infect. 2020;53(1):69-78. doi: 10.1016/j.jmii.2017.12.005
Hsueh WA, Lyon CJ, Quiñones MJ. Insulin resistance and the endothelium. Am J Med. 2004;117(2):109-117. doi: 10.1016/j.amjmed.2004.02.042
Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC. Dengue. Lancet. 2024;403(10427):667-682. doi: 10.1016/s0140-6736(23)02576-x
Tsheten T, Clements AC, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty. 2021;10(1):123. doi: 10.1186/s40249-021-00908-2
Dandona P, Aljada A, Chaudhuri A, Mohanty P. Endothelial dysfunction, inflammation, and diabetes. Rev Endocr Metab Disord. 2004;5(3):189-197. doi: 10.1023/b:remd.0000032407.88070.0a
Lu HZ, Xie YZ, Gao C, et al. Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: a meta-analysis. PLoS Negl Trop Dis. 2024;18(5):e0012217. Doi: 10.1371/journal.pntd.0012217
Bisanzio D, Estofolete CF, Reithinger R. Dengue and diabetes comorbidity: an emerging public health threat. Int Health. Published online December 16, 2024. doi:10.1093/inthealth/ihae089. doi: 10.1093/inthealth/ihae089
Marques-Vidal P, Bastardot F, von Känel R, et al. Association between circulating cytokine levels, diabetes and insulin resistance in a population-based sample (CoLaus study). Clin Endocrinol (Oxf). 2013;78(2):232-241. doi: 10.1111/j.1365-2265.2012.04487.x
Elimam H, Abdulla AM, Taha IM. Inflammatory markers and control of type 2 diabetes mellitus. Diabetes Metab Syndr. 2019;13(1):800-804. doi: 10.1016/j.dsx.2018.11.061
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-86. doi: 10.1038/nature05485.
Masenga SK, Kabwe LS, Chakulya M, Kirabo A. Mechanisms of oxidative stress in metabolic syndrome. Int J Mol Sci. 2023;24(9):7898. doi:10.3390/ijms24097898.
Zheng D, Dou J, Liu G, et al. Association between triglyceride level and glycemic control among insulin-treated patients with type 2 diabetes. J Clin Endocrinol Metab. 2019;104(4):1211-1220. doi:10.1210/jc.2018-01784. Doi: 10.1210/jc.2018-01656
Sobieska K, Buczyńska A, Krętowski AJ, Popławska-Kita A. Iron homeostasis and insulin sensitivity: unraveling the complex interactions. Rev Endocr Metab Disord. 2024;25(5):925-939. doi: 10.1007/s11154-024-09908-7
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327–334. doi: 10.1001/jama.286.3.327
Stanimirovic J, Radovanovic J, Banjac K, et al. Role of C‐reactive protein in diabetic inflammation. Mediators Inflamm. 2022;2022:3706508. doi:10.1155/2022/3706508.
Issop A, Bertolotti A, Diarra YM, et al. Dengue clinical features and harbingers of severity in the diabetic patient: A retrospective cohort study on Reunion Island, 2019. Travel Med Infect Dis. 2023;54:102586. doi: 10.1016/j.tmaid.2023.102586
Marcos-Pérez D, Sánchez-Flores M, Proietti S, et al. Association of inflammatory mediators with frailty status in older adults: results from a systematic review and meta-analysis. GeroScience. 2020;42(6):1451-1473. doi: 10.1007/s11357-020-00247-4
Chen LC, Lei HY, Liu CC, et al. Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients. Am J Trop Med Hyg. 2006;74(1):142-147. doi: 10.4269/ajtmh.2006.74.142
Latt KZ, Poovorawan K, Sriboonvorakul N, Pan-ngum W, Townamchai N, Muangnoicharoen S. Diabetes mellitus as a prognostic factor for dengue severity: retrospective study from Hospital for Tropical Diseases, Bangkok. Clin Infect Pract. 2020;7:100028. doi:10.1016/j.clinpr.2020.100028.
Figueiredo MA, Rodrigues LC, Barreto ML, et al. Allergies and diabetes as risk factors for dengue hemorrhagic fever: results of a case control study. PLoS Negl Trop Dis. 2010;4(6):e699. doi:10.1371/journal.pntd.0000699
Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215-2222. doi: 10.1016/s0140-6736(10)60484-9
Singh R, Goyal S, Aggarwal N, et al. Study on dengue severity in diabetic and non-diabetic population of tertiary care hospital by assessing inflammatory indicators. Ann Med Surg (Lond). 2022;82:104713. doi: 10.1016/j. amsu.2022.104710
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