Ensure vaccinations are up to date for your patients with diabetes!

Influenza season is in full swing and it’s important to ensure all our patients with diabetes are vaccinated against the flu. It is also a good time to ensure that their immunizations against other infections are up to date. Diabetes Canada recently released an update of the immunization guidelines for adults living with diabetes.1Why is it important for patients to get vaccinated if they have diabetes?People with diabetes are at higher risk for complications from vaccine-preventable diseases, even if their blood glucose levels are well controlled.2 In addition, instances of hyperglycemia can reduce the ability of white blood cells to fight infections.3 Overall, infections are an important adverse outcome for people with diabetes, with higher rates of mortality and morbidity in comparison to those that do not have diabetes.4What vaccines should my patients receive?Vaccines that people with diabetes should receive fall into two categories: annual/ongoing and one-time immunization series.Annual/ongoing vaccinationsPatients with diabetes should receive COVID-19 and influenza vaccines annually, and a tetanus/diphtheria/pertussis or tetanus/diphtheria booster every 10 years.1COVID-19 vaccination is recommended for all previously vaccinated and unvaccinated adults 18 years or older with diabetes. Most people can receive one dose per year; however, those at higher risk (age ≥ 80, residents of long-term care homes, moderately-severely immunocompromised) should receive two doses per year.5 Data from the United Kingdom have shown that diabetes is associated with 1.5-fold and 1.8-fold greater mortality from COVID-19 in unvaccinated women and men, respectively.4Influenza virus has been known to cause extremely high blood glucose levels in patients with diabetes.2 People with diabetes are also at higher risk of complications from influenza, including hospitalization or death.2,6 In a study of patients with diabetes who were vaccinated against influenza, a 46% lower mortality rate and an 11% lower hospitalization rate were reported compared to those not vaccinated.4 Influenza vaccine does not provide 100% protection, but lowers the chance of getting the flu and reduces the chances of severe adverse effects, such as pneumonia and bronchitis, or being hospitalized.3Tetanus/diphtheria/pertussis Adults should receive a booster of the combination vaccine Tdap (tetanus/diphtheria/acellular pertussis) or Td (tetanus/diphtheria) every 10 years.2,7 These vaccines help provide protection against tetanus (which may cause severe muscle spasms and possibly locking of the jaw), diphtheria (which may lead to breathing issues, heart failure, paralysis or death), and pertussis (which may cause severe coughing spells making it difficult to breathe, sleep or eat).2One-time immunization seriesPeople with diabetes should receive a one-time immunization series with the following vaccines: pneumococcal vaccine, herpes zoster, respiratory syncytial virus and hepatitis B.1Hepatitis B People with diabetes are at higher risk of hepatitis B infection, which may be spread through the sharing of blood glucose meters, lancets or insulin pens (which should be strongly discouraged).2 If infected with hepatitis B, people may carry the virus as a chronic infection leading to liver cirrhosis, liver cancer or death.2 Vaccination against hepatitis B normally occurs in childhood, but can be given at any time to nonimmunized adults. Protection is normally lifelong; however, a booster dose may be required in those who are immunocompromised or those who develop chronic kidney disease or require dialysis.8Pneumococcal vaccine Pneumococcal disease is caused by bacteria that may lead to pneumonia, bacteremia and meningitis, putting people with diabetes at increased risk of hospitalization and death.2,6 Adults 65 years of age or older and those that are under 65 years of age with risk factors for invasive pneumococcal disease, including diabetes, should receive one dose of pneumococcal 20-valent conjugate vaccine (Pneu-C-20) or pneumococcal 21-valent conjugate vaccine (Pneu–C-21).9 These should be given regardless of vaccination history with pneumococcal 13-valent conjugate vaccine (Pneu-C-13), pneumococcal 15-valent conjugate vaccine (Pneu-C-15) or pneumococcal polysaccharide 23-valent vaccine (Pneu-P-23).9 Adults with diabetes aged 18–64 may also benefit from the pneumococcal vaccine.1Respiratory syncytial virus (RSV) is a respiratory virus that typically causes mild, cold-like symptoms; however, in those with diabetes, infection may lead to an increased risk of hospitalization or severe complications such as pneumonia or bronchiolitis.2,3 The RSV vaccine is recommended in patients over 75 years of age regardless of other health conditions and should be considered in those 50–74 years of age with underlying chronic conditions such as diabetes.10Herpes zoster (shingles) Varicella zoster virus causes two distinct syndromes—the primary infection syndrome presents as varicella (chicken pox) and the secondary syndrome (herpes zoster) is the reactivation of the latent varicella zoster virus in the cranial nerve or dorsal root ganglia. Herpes zoster presents as painful blisters or a rash, also known as shingles.6,11 It has also been reported to lead to a loss of vision or hearing.2 The most common complication of herpes zoster is postherpetic neuralgia pain, which can persist several months after the lesions have healed.6 Having diabetes may increase the risk for developing herpes zoster and post-herpetic neuralgia.11 The herpes zoster vaccine is recommended for patients 50 years of age or older.12SummaryPharmacists should educate patients with diabetes about recommended vaccines, the benefits of vaccination and risks of not being vaccinated. With most Canadian jurisdictions now allowing pharmacists to administer various vaccines, pharmacists should offer recommended vaccinations at every opportunity— and refer patients to other healthcare providers when needed. Ensuring that patients with diabetes are up to date with their vaccinations will prevent many infections, complications and/or hospitalizations. Take the time to do a vaccination history with your patients with diabetes; up-to-date immunizations will help protect them and others.Rhonda Roedler is a pharmacist in Calgary, AB. She maintains an ambulatory clinical practice in diabetes.References:Immunizations recommended for adults living with diabetes. (accessed July 23, 2025).National Foundation for Infectious Diseases. Vaccines and diabetes. (accessed July 23, 2025).American Diabetes Association – Vaccinations. (accessed July 23, 2025).Bloomgarden Z. Risks and benefits of vaccines in diabetes (editorial). J Diabetes 2023;15:806-7.Government of Canada. COVID-19 vaccines: Canadian Immunization Guide. (accessed July 23, 2025).Husein N, Chetty A. Influenza, pneumococcal, hepatitis B and herpes zoster vaccinations. (accessed July 23, 2025).Government of Canada. Pertussis (whooping cough) vaccines: Canadian Immunization Guide. (accessed July 25, 2025).Government of Canada. Hepatitis B vaccines: Canadian Immunization Guide. (accessed July 25, 2025).Government of Canada. Pneumococcal vaccines: Canadian Immunization Guide. (accessed July 25, 2025).Government of Canada. Updated guidance on respiratory syncytial virus (RSV) vaccines for older adults including the expanded use of RSVPreF3 for individuals 50-59 years of age and use of the new mRNA-1345 vaccine. (accessed July 25, 2025).Huang CT, Lee CY, Sung HY, et al. Association between diabetes mellitus and the risk of herpes zoster: a systematic review and meta-analysis. J Clin Endocrinol Metab 2022; 07:586-97.Government of Canada. Herpes zoster (shingles) vaccine: Canadian Immunization Guide. (accessed September 15, 2025).

Ensure vaccinations are up to date for your patients with diabetes!

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