Vaccination Coverage in Patients With Diabetes

Hospitalization and interprofessional team management, particularly the involvement of a pharmacist, are essential in vaccination coverage for patients with diabetes.

Preventive care is vital for the diabetic patient population. Currently, 37.3 million people in the United States have diabetes and 96 million people over 18 years of age have prediabetes.

Vaccines are an important example of primary prevention for these patients. Patients with diabetes have a higher risk of infection, which comes with greater complications than among healthy individuals.

The most common infections that arise in patients with diabetes are influenza and pneumococcal infections, which are both vaccine preventable. The CDC recommends patients with diabetes receive the influenza vaccine annually; Tdap vaccine every 10 years, zoster vaccine at 50 years of age; pneumococcal vaccine once before 65 years of age then 2 more doses after 65; and hepatitis B vaccine before 60 years of age.

A 2019 observational study conducted in France by the Endocrinology-Nutrition-Diabetes Department of the University Hospital of Montpellier shows that hospital admissions can increase vaccination coverage in diabetic patients. A multivariable logistic regression analysis assessed coverage for the tetanus, Tdap, pneumococcal, influenza, and herpes zoster vaccines.

The study observed coverage of 222 hospitalized patients with diabetes from the point of admission to discharge. All patients over age 18 with type 1 or 2 diabetes were eligible for the study. The majority of patients (68.5%) had type 2 diabetes.

The medical team divided patients into 3 units. Unit 1 consisted of a full-time pharmacist who actively participated in the multidisciplinary management of patients.

Unit 2 also had a full-time pharmacist; however, the pharmacist was not involved in patient management. Unit 3 was the only weekday unit in which there was no full-time pharmacist.

A pharmaceutical team member completed a medication reconciliation within 24 hours of hospital admission. A 10-minute questionnaire investigated patients’ vaccine coverage and knowledge of current recommendations.

The study showed that only 14 of 222 patients had complete vaccination coverage at admission for 1 of the 3 vaccines. Factors associated with vaccine coverage included female sex, diabetes care unit with a team of clinical pharmacists, immunization coverage with the pneumococcal vaccine, and documentation in the medical record.

Ultimately, vaccine coverage increased by 26.7%, 188%, and 8.9% for the Tdap, pneumococcal, and influenza vaccines, respectively. This demonstrated that high-risk diabetic patients benefited from hospital stays and medication reviews.

The study indicates that hospital stays in an endocrinology department can improve coverage for patients with diabetes. The study also found that patients had poor knowledge of the recommended vaccines that could factor into their skepticism.

The authors concluded that hospitalization and interprofessional team management, particularly the involvement of a pharmacist, are essential in vaccination coverage for patients with diabetes.

About the Author

Karisse Lora is a 2023 PharmD candidate at the University of Connecticut.

REFERENCE

Lohan L, Cool C, Viault L, et al. Impact of Hospitalization in an Endocrinology Department on Vaccination Coverage in People Living with Diabetes: A Real-Life Study. Medicina (Kaunas). 2022;58(2):219. Published 2022 Feb 1. doi:10.3390/medicina58020219