Perspectives on Diabetes Care

How to Talk to People with Diabetes Who are Reluctant to Getting Vaccinated

Feb 20, 2019, 09:38 AM

by Melissa Young, PharmD, RPh, BC-ADM, CDE

People with diabetes (PWDs) are more susceptible to vaccine-preventable illness and diseases than the general public; unfortunately, many PWDs are not aware of this risk to their health. Educational visits are an opportune time for diabetes educators to promote vaccines as part of an effective strategy for preventative care.

Here are five vaccines that educators should promote among PWD’s to reduce the risk of severe infection and complications.

• Influenza (flu)
• Pneumococcal
• Tdap (Tetanus, Diphtheria, Pertussis)
• Hepatitis B
• Zoster (shingles)

During flu season, it is critical that individuals with diabetes receive the influenza and pneumococcal vaccines. The CDC estimates almost 80,000 Americans died from influenza and related complications during the 2017-2018 flu season and only 37% of adult Americans received flu vaccine.^1,2 Influenza vaccine uptake in American adults has been historically low, often due to misperceptions about the burden/severity of flu infection and a lack of confidence in vaccine efficacy.³

I had the opportunity to participate in a multi-disciplinary Roundtable discussion conducted by the National Foundation for Infectious Diseases (NFID) to explore the risks of influenza infection and the benefits of vaccination in adults with chronic diseases. Adapted from the resulting NFID Call to Action are five strategies to help motivate people with chronic conditions to accept influenza vaccination.³ In addition, education tips pertinent to people with diabetes are included.

1. Provide a Strong, Clear Recommendation
   Stating a strong, clear message of need for vaccination can help to combat misperceptions about the severity of influenza infection. If vaccination is to occur at a local pharmacy, provide a written order or note to reinforce your recommendation. The Standards on Adult Immunization Practice also recommend appropriate follow up and documentation of the referral.
2. Communicate about Potential Worsening of Chronic Condition
   Educate about the risks of diabetes exacerbation and don’t forget about exacerbation of complications. For instance, educate PWD’s with heart disease about the recent study associating a significant risk of heart attack associated with flu infection.⁴ Or discuss the 2013 meta-analysis that documented secondary prevention benefits of the influenza vaccine, particularly in people with high-risk CVD.⁵
3. Explain Risk of Post-Infection Frailty
   Describe the possible long-term illness burden and the potential permanent loss of function and/or independence that could occur as a result of contracting a vaccine-preventable illness. Diabetes itself carries a significant risk for excess frailty. Stress the added effects of influenza and related complications that may reduce the ability to enjoy activities and increase burden on family as caretakers.
4. Emphasize Benefits of Disease Mitigation
   No vaccine is 100% effective in preventing disease, but the benefits of immunization outweigh the risks of natural infection. The influenza vaccine reduces the severity and risk of long-term consequences of the flu if a vaccinated person becomes infected.
5. Stress that Vaccination is a Social Responsibility
   A person who is vaccinated reduces transmission to others in the community, such as those who are ineligible for the vaccination (e.g. the very young), or the very elderly with weakened immune response to vaccines.

I hope the strategies and tips help motivate your clients to say “yes” when it comes to receiving vaccines. For additional guidance and information on vaccines for adults with diabetes, check out this page featuring AADE's new practice paper, Vaccination Practices for Adults with Diabetes. The CDC’s animated infographic on the importance of vaccines for people with diabetes also offers a printable guide you can use in your practice. Please add comments to describe strategies you have used to increase vaccine uptake in your clients.

References:

¹Centers for Disease Control and Prevention. Estimates of Influenza Illnesses, Medical Visits, Hospitalizations and Deaths in the United States: 2017 – 2018 flu season. https://www.cdc.gov/flu/about/burden/estimates.htm. Accessed October 25, 2018.

²Centers for Disease Control and Prevention. Estimates of Influenza Vaccination Coverage among Adults- United States: 2017 – 2018 Flu Season. https://www.cdc.gov/flu/fluvaxview/coverage-1718estimates.htm. Accessed October 25, 2018.

³Adapted from the National Foundation for Infectious Diseases Call to Action: The Dangers of Influenza and Benefits of Vaccination in Adults with Chronic Health Conditions (September 2018). Found at http://www.nfid.org/idinfo/influenza/cta-dangers-of-influenza-in-adults-with-chronic-health-c.pdf. Courtesy of the National Foundation for Infectious Diseases. Accessed October 18, 2018.

⁴Kwong, J. and Schwartz, K., et al. (2018). Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. New England Journal of Medicine. N Engl J Med 2018; 378:345-353. DOI: 10.1056/NEJMoa1702090.

⁵Udell JA, Zawi R, Bhatt DL, et al. Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients. A Meta-analysis. JAMA. 2013;310(16):1711–1720. doi:10.1001/jama.2013.279206.

About the author:

Dr. Melissa Young is a clinical pharmacist with 20-years of experience in diabetes education and management. She is a Certified Diabetes Educator and has earned a Board Certification in Advanced Diabetes Management. She specializes in the treatment of adults with complex diabetes and metabolic disorders while providing chronic disease management services for veterans. Dr. Young holds a teaching affiliation with the University of Utah and leads a national committee for the American Association of Diabetes Educators. Her current interests include opioid safety, disease prevention, and matters related to healthcare policy.