Both cohorts under study, with or without prior DF hospitalizations, were significantly different in several respects: the cohort with prior hospitalizations was younger, contained more males, had more comorbidities and was more frequently treated with insulin, while the adjusted risks of death for each complication appeared substantially more impacting after a first hospitalization more closely related to ischemic vascular complications such as amputations and gangrene. Here, INS is linked to dengue disease.