Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Postbox 4404, Nydalen, 0403, Oslo, Norway.
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
Diabetologia. 2018 Sep;61(9):1996-2004. doi: 10.1007/s00125-018-4662-7. Epub 2018 Jun 22.
AIMS/HYPOTHESIS: Case reports have linked influenza infections to the development of type 1 diabetes. We investigated whether pandemic and seasonal influenza infections were associated with subsequent increased risk of type 1 diabetes.
In this population-based registry study, we linked individual-level data from national health registries for the entire Norwegian population under the age of 30 years for the years 2006-2014 (2.5 million individuals). Data were obtained from the National Registry (population data), the Norwegian Patient Registry (data on inpatient and outpatient specialist care), the Primary Care Database, the Norwegian Prescription Database and the Norwegian Surveillance System for Communicable Diseases. Pandemic influenza was defined as either a clinical influenza diagnosis during the main pandemic period or a laboratory-confirmed test. Seasonal influenza was defined by a clinical diagnosis of influenza between 2006 and 2014. We used Cox regression to estimate HRs for new-onset type 1 diabetes after an influenza infection, adjusted for year of birth, sex, place of birth and education.
The adjusted HR for type 1 diabetes after pandemic influenza infection was 1.19 (95% CI 0.97, 1.46). In the subgroup with laboratory-confirmed influenza A (H1N1), influenza was associated with a twofold higher risk of subsequent type 1 diabetes before age 30 years (adjusted HR: 2.26, 95% CI 1.51, 3.38).
CONCLUSIONS/INTERPRETATION: Overall, we could not demonstrate a clear association between clinically reported pandemic influenza infection and incident type 1 diabetes. However, we found a twofold excess of incident diabetes in the subgroup with laboratory-confirmed pandemic influenza A (H1N1).
目的/假设：病例报告将流感感染与 1 型糖尿病的发生联系起来。我们调查了大流行性流感和季节性流感感染是否与随后发生 1 型糖尿病的风险增加有关。
在这项基于人群的登记研究中，我们将整个挪威 30 岁以下人群的个人层面数据与 2006 年至 2014 年的国家健康登记数据相关联（250 万人）。数据来自国家登记处（人口数据）、挪威患者登记处（住院和门诊专科护理数据）、初级保健数据库、挪威处方数据库和挪威传染病监测系统。大流行性流感的定义是在主要大流行期间出现临床流感诊断或实验室确诊的流感。季节性流感的定义是 2006 年至 2014 年期间出现临床诊断的流感。我们使用 Cox 回归来估计流感感染后新发 1 型糖尿病的 HR，调整了出生年份、性别、出生地和教育程度。
大流行性流感感染后 1 型糖尿病的调整 HR 为 1.19（95%CI 0.97，1.46）。在经实验室确诊的甲型流感（H1N1）亚组中，流感与 30 岁前发生 1 型糖尿病的风险增加两倍相关（调整 HR：2.26，95%CI 1.51，3.38）。
结论/解释：总体而言，我们无法证明临床报告的大流行性流感感染与 1 型糖尿病的发生之间存在明确关联。然而，我们发现经实验室确诊的甲型流感（H1N1）亚组中糖尿病的发病率增加了两倍。
