Impact of influenza vaccination on all-cause mortality and hospitalization for pneumonia in adults and the elderly with diabetes: A meta-analysis of observational studies

Diabetes is a chronic condition that can be worsened by complications such as seasonal influenza virus infections. The aim of the present meta-analysis is the systematic retrieval and analysis of all available evidence on the effects of an influenza vaccine on diabetic patients. We conducted a systematic review and meta-analysis by searching MEDLINE, Embase and the Cochrane databases from inception until April 2019. We included all types of studies reporting on the effectiveness of influenza vaccination in adult and elderly patients with type 1 and type 2 diabetes. The Newcastle-Ottawa scale was used to assess risk of bias, the GRADE methodology was used to assess the evidence for each outcome. A total of 2261 studies were identified, of those, 6 studies completely fulfilled the inclusion criteria. In the 6 studies included in the analysis, influenza vaccination was associated with a lower mortality rate (Mantel Haenszel Odds Ratio (MH-OR), 95% CI: 0.54 (0.40; 0.74), p < 0.001). Patients who received influenza vaccination showed a lower risk of hospitalization for pneumonia (MH-OR, 95% CI: 0.89; (0.80; 0.98), p = 0.18). A sensitivity analysis using fixed effect model confirmed the results (MH-OR, 95% CI: 0.91; (0.87; 0.96); p = 0.001). The results of this meta-analysis are clinically relevant and support the recommendation for all persons with diabetes to receive influenza vaccination.