Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy.
Coordinator Working Group "Vaccines and Immunization Policies", Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Terni, Italy.
Acta Diabetol. 2024 Aug;61(8):1029-1039. doi: 10.1007/s00592-024-02282-5. Epub 2024 Apr 29.
To collect all available evidence on the effect of diabetes mellitus (DM) as a risk factor for pneumococcal disease incidence and related complications, and on the efficacy/effectiveness of vaccines in patients with DM.
Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and EMBASE databases were performed, one for each meta-analysis, collecting all observational (cohort and case-control) studies and randomized clinical trials performed on humans up to June 1st, 2023.
We retrieved 36 observational studies comparing risk for pneumococcal disease and related complications in people with or without DM, and 11 studies (1 randomized clinical trial and 10 observational studies) assessing conjugated and polysaccaridic vaccines efficacy/effectiveness on preventing such outcomes. People with DM were at higher risk for Invasive Pneumococcal Disease (unadjusted OR 2.42 [2.00; 2.92]); Case-Fatality Rate (unadjusted OR 1.61 [1.25; 2.07], Pneumococcal pneumonia (unadjusted OR 2.98 [2.76; 3.22), and Intensive care unit admission for pneumococcal disease (unadjusted OR 2.09 [1.20; 3.66]). In diabetic individuals vaccinated with conjugated vaccine, incidence of pneumonia specific for vaccine type in a clinical trial (OR 0.237 [0.008; 0.704]), and hospitalization for overall pneumonia during the year following the polysaccharide vaccination in observational studies (unadjusted OR 0.63 [0.45-0.89]) were significantly lower in comparison with unvaccinated DM subjects, with no significant differences for other outcomes.
People with diabetes mellitus are at higher risk for less favourable course of pneumococcal disease and should be therefore targeted in vaccination campaigns; more evidence needs to be collected on vaccination outcomes in people with diabetes.
收集所有关于糖尿病（DM）作为肺炎球菌病发病和相关并发症的风险因素的现有证据，以及糖尿病患者使用疫苗的疗效/效果。
对 MEDLINE、Cochrane、ClinicalTrials.gov 和 EMBASE 数据库进行了两次独立的系统搜索，分别针对每项荟萃分析，收集截至 2023 年 6 月 1 日在人类身上进行的所有观察性（队列和病例对照）研究和随机临床试验。
我们检索了 36 项比较糖尿病患者与非糖尿病患者发生肺炎球菌病和相关并发症风险的观察性研究，以及 11 项评估结合疫苗和多糖疫苗预防此类结局的疗效/效果的研究（1 项随机临床试验和 10 项观察性研究）。患有糖尿病的人患侵袭性肺炎球菌病的风险更高（未调整的 OR 2.42 [2.00；2.92]）；病死率（未调整的 OR 1.61 [1.25；2.07]）、肺炎球菌肺炎（未调整的 OR 2.98 [2.76；3.22]）和因肺炎球菌病入住重症监护病房（未调整的 OR 2.09 [1.20；3.66]）。在接受结合疫苗接种的糖尿病患者中，临床试验中肺炎球菌病特定类型肺炎的发病率（OR 0.237 [0.008；0.704]），以及观察性研究中多糖疫苗接种后一年内因肺炎住院的发生率（未调整的 OR 0.63 [0.45-0.89]）与未接种 DM 受试者相比显著降低，但其他结局无显著差异。
患有糖尿病的人患肺炎球菌病不良预后的风险更高，因此应在疫苗接种活动中针对他们；需要更多证据来收集糖尿病患者的疫苗接种结果。
