Abstract
Following the 2009 H1N1 influenza virus pandemic, numerous studies identified the striking link between diabetes mellitus and influenza disease severity. Typically, influenza virus is a self-limiting infection but in individuals who have a pre-existing chronic illness, such as diabetes mellitus, severe influenza can develop. Here, we discuss the latest clinical and experimental evidence for the role of diabetes in predisposing the host to severe influenza. We explore the possible mechanisms that underlie this synergy and highlight the, as yet, unexplored role that blood glucose oscillations may play in disease development. Diabetes is one of the world’s fastest growing chronic diseases and influenza virus represents a constant and pervasive threat to human health. It is therefore imperative that we understand how diabetes increases influenza severity in order to mitigate the burden of future influenza epidemics and pandemics.
Highlights
Every year, approximately 5–15% of the world’s population are infected with influenza virus (Shirey et al, 2013)
This pandemic highlighted that people with diabetes suffered from more severe influenza than people with no underlying medical condition (Allard et al, 2010; Wilking et al, 2010)
We further highlight the specific roles that high, and/or oscillating, blood glucose levels may play in the severity of influenza virus
Summary
Approximately 5–15% of the world’s population are infected with influenza virus (Shirey et al, 2013). This interaction between chronic disease and influenza was evident after the 2009 H1N1 influenza pandemic (Kumar et al, 2009) This pandemic highlighted that people with diabetes suffered from more severe influenza than people with no underlying medical condition (Allard et al, 2010; Wilking et al, 2010). Whilst the majority of clinical studies suggest a role for diabetes in increasing influenza severity, this synergism was not observed in all studies (see Table 1). Consistent with the majority of clinical observations, murine models demonstrate that diabetes increases susceptibility to severe infections with both seasonal and highly pathogenic influenza virus strains (see Table 2)
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