Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7years follow up study.

OBJECTIVES: We aim to determine influenza vaccination uptake among people with diabetes included in the MADIABETES cohort study in order to identify predictors of uptake and to analyze reasons for adherence and non-adherence with vaccination. METHODS: Using data from the MADIABETES Study we conducted a retrospective case record form based study without controls. We included outpatients with type 2 diabetes mellitus. Information was obtained from computerized clinical records and by telephone survey. The main dependent variables were influenza vaccination uptake in the year 2013 and the reason for receiving or refusing vaccination. RESULTS: Overall, 65.7% had received the influenza vaccine in 2013. The mean number of influenza vaccines received from 2007 to 2013 was 3.24 (SD1.15), although 19.23% had not received any influenza vaccine and 23.3% had been vaccinated against pneumococcus. The variables that increased the probability of being vaccinated were inclusion in the age-based recommendation (⩾60years), having a chronic respiratory disease, previous pneumococcal vaccination, higher number of visits to the general practitioner, higher number of influenza vaccines, and longer time since diabetes diagnosis. A higher mean glycated haemoglobin value in 2013 was associated with a reduced probability of vaccination. Most patients (90%) agreed to be vaccinated following their physician's advice because of their age or their chronic conditions. The most common reason for refusal among men was the belief that they were not at risk (41.6% vs. 29.79% in women); the most common reason for refusal among women was fear of adverse reactions (32.53% vs. 20.23% in men). CONCLUSIONS: The uptake of influenza vaccination among diabetic patients in the present study was below desirable levels. The main barrier to vaccination was lack of knowledge regarding the need for and risks and advantages of influenza vaccination. Healthcare professionals should educate and encourage influenza vaccination among people with diabetes.

Five-year incidence of chronic kidney disease (stage 3-5) and associated risk factors in a Spanish cohort: the MADIABETES Study.

OBJECTIVE: To evaluate the incidence rate of Chronic Kidney Disease (CKD) stage 3-5 (persistent decreased kidney function under 60 mL/min per 1.73 m2) among patients with type 2 diabetes over five years, to identify the risk factors associated with CKD, and develop a risk table to predict five-year CKD stage 3-5 risk stratification for clinical use. DESIGN: The MADIABETES Study is a prospective cohort study of 3,443 outpatients with type 2 diabetes mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain). RESULTS: The cumulative incidence of CKD stage 3-5 at five-years was 10.23% (95% CI = 9.12-11.44) and the incidence density was 2.07 (95% CI = 1.83-2.33) cases per 1,000 patient-months or 2.48 (95% CI = 2.19-2.79) cases per 100 patient-years. The highest hazard ratio (HR) for developing CKD stage 3-5 was albuminuria ≥ 300 mg/g (HR = 4.57; 95% CI= 2.46-8.48). Furthermore, other variables with a high HR were age over 74 years (HR = 3.20; 95% CI = 2.13-4.81), a history of Hypertension (HR = 2.02; 95% CI = 1.42-2.89), Myocardial Infarction (HR= 1.72; 95% IC= 1.25-2.37), Dyslipidemia (HR = 1.68; 95% CI 1.30-2.17), duration of diabetes mellitus ≥ 10 years (HR = 1.46; 95% CI = 1.14-1.88) and Systolic Blood Pressure >149 mmHg (HR = 1.52; 95% CI = 1.02-2.24). CONCLUSIONS: After a five-year follow-up, the cumulative incidence of CKD is concordant with rates described in Spain and other countries. Albuminuria ≥ 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5). Blood Pressure, lipid and albuminuria control could reduce CKD incidence of CKD in patients with T2DM.