PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：收集关于糖尿病（DM）作为肺炎球菌疾病发病率和相关并发症的危险因素的影响的所有现有证据，以及疫苗在DM患者中的功效/有效性。
方法：在MEDLINE上进行两种不同的系统搜索，科克伦,进行了ClinicalTrials.gov和EMBASE数据库，每个荟萃分析一个，收集截至6月1日在人体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，2023年。
结果：我们检索了36项观察性研究，比较了患有或不患有DM的人的肺炎球菌疾病和相关并发症的风险。11项研究（1项随机临床试验和10项观察性研究）评估了结合疫苗和多糖疫苗预防此类结局的功效/有效性。DM患者发生侵袭性肺炎球菌疾病的风险较高（未调整OR2.42[2.00;2.92]）；病死率（未调整OR1.61[1.25;2.07]，肺炎球菌肺炎（未调整OR2.98[2.76;3.22），和重症监护病房的肺炎球菌疾病（未调整OR2.09[1.20;3.66]）。在接种结合疫苗的糖尿病个体中，临床试验中疫苗类型特异性肺炎的发病率（OR0.237[0.008;0.704]），与未接种的DM受试者相比，观察性研究中的多糖疫苗接种后一年的整体肺炎住院率（未调整OR0.63[0.45-0.89]）显着降低，其他结果没有显著差异。
结论：糖尿病患者患肺炎球菌疾病的风险较高，因此应作为疫苗接种运动的目标；需要收集更多关于糖尿病患者疫苗接种结果的证据。
方法：在MEDLINE上进行两种不同的系统搜索，科克伦,进行了ClinicalTrials.gov和EMBASE数据库，每个荟萃分析一个，收集截至6月1日在人体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，2023年。
结果：我们检索了36项观察性研究，比较了患有或不患有DM的人的肺炎球菌疾病和相关并发症的风险。11项研究（1项随机临床试验和10项观察性研究）评估了结合疫苗和多糖疫苗预防此类结局的功效/有效性。DM患者发生侵袭性肺炎球菌疾病的风险较高（未调整OR2.42[2.00;2.92]）；病死率（未调整OR1.61[1.25;2.07]，肺炎球菌肺炎（未调整OR2.98[2.76;3.22），和重症监护病房的肺炎球菌疾病（未调整OR2.09[1.20;3.66]）。在接种结合疫苗的糖尿病个体中，临床试验中疫苗类型特异性肺炎的发病率（OR0.237[0.008;0.704]），与未接种的DM受试者相比，观察性研究中的多糖疫苗接种后一年的整体肺炎住院率（未调整OR0.63[0.45-0.89]）显着降低，其他结果没有显著差异。
结论：糖尿病患者患肺炎球菌疾病的风险较高，因此应作为疫苗接种运动的目标；需要收集更多关于糖尿病患者疫苗接种结果的证据。
