Using Claims and Consumer Wearable Devices Data to Quantify Influenza-Related Outcomes among Type 2 Diabetes Patients—A Large Population Study

Abstract

Influenza causes substantial morbidity in people with diabetes; annual vaccination is recommended. We conducted a retrospective study of influenza-related outcomes (IRO) among fully insured type 2 diabetics from a large U.S. payer over a 1 year period covering the 2016-17 influenza season. We used bivariate analysis (54,656 diabetics, mean age 54.8 years, s.d. = 10.2) to compare IRO’s inferred from claims data against IRO’s for 113,016 age and gender matched nondiabetics. Diabetics had more influenza events (per ICD-9 and ICD-10 codes, 1.96% vs. 1.37%, p<0.001), and were prescribed more influenza antivirals per 100 ppl (27.1 vs. 22, p<0.001). Within 2-weeks before and 4-weeks after a medical claim for influenza, diabetics with influenza had more observed hyperglycemic events than in a comparable non-influenza period in the same year (3.81% vs. 2.18%, p<0.001), with substantial increases in pneumonia, sepsis and coronary disease (5.5% vs. 0.7%, 5.5% vs. 3.5%, 1.6% vs. 0.3%, p<0.001), and more outpatient antibiotic use per 100 people (54.5 vs. 16.9, p<0.001). 8.2% of type 2 diabetics (vs. 9.1% controls, p<0.001) used commercially available activity and sleep trackers, sharing data through an insurer provided wellness platform. Activity trackers showed that diabetics slept fewer hours compared to controls (6.48 vs. 6.69 hours, p<0.001), and had statistically significant changes in sleep and walking habits in the days around an influenza event as compared to baseline (about 2% more of the night spent restless and 10k fewer steps). This is the first population scale study to use medical claims linked with activity tracking data to quantify the behavioral and clinical effects of influenza in type 2 diabetes. These data highlight the impact of influenza on glycemic control and the daily lives of the Diabetic population, and reinforce the need for annual influenza vaccine, as recommended by the WHO and other global public health bodies. Disclosure S.I. Samson: Employee; Self; Sanofi Pasteur. W. Lee: None. T. Quisel: None. L. Foschini: None. J. Liska: Employee; Self; Sanofi. H.G. Mills: Employee; Self; Sanofi. R.C. Hollingsworth: Employee; Self; Sanofi Pasteur. M.E. Greenberg: Stock/Shareholder; Self; Merck & Co., Inc.. Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi, GlaxoSmithKline plc., Pfizer Inc. A.C. Beal: Employee; Self; Sanofi. Board Member; Self; AcademyHealth.