November 20, 2018

Melissa Young


Special thanks to Melissa D. Young, PharmD, RPh, BC-ADM, CDE, Chair of the National Credential Oversight Committee for the American Association of Diabetes Educators (AADE), for this guest blog post about the importance of vaccines for people with diabetes, originally posted on the AADE Blog.

As the holiday season approaches, many will prepare to gather with family and friends to celebrate and give thanks. People with diabetes are more susceptible to contagious illnesses, so pre-holiday visits are an opportune time to educate patients and promote vaccination.

There are five vaccines that people with diabetes need to reduce the risk of severe infection and related complications:

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


With flu season currently upon us, it is critical that people with diabetes receive flu and pneumococcal vaccines. The Centers for Disease Control and Prevention (CDC) estimates that in the US, almost 80,000 individuals died from flu and related complications during the 2017-2018 flu season and only 37% of US adults received flu vaccine. Flu vaccine uptake in US adults has been historically low, often due to misperceptions about the burden/severity of flu infection and a lack of confidence in vaccine efficacy.

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

  1. Provide a Strong, Clear Recommendation
    Sending a strong, clear message of the need for vaccination can help to break down misperceptions about the severity of influenza infection and the benefit of vaccination. If the vaccination is to be given at a local pharmacy, provide a written order or note to reinforce your recommendation.
  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 patients with heart disease about the recent study showing a significant risk of heart attack associated with flu infection. Or discuss the 2013 meta-analysis that documented secondary prevention benefits of the flu vaccine, particularly in individuals with high-risk cardiovascular disease.
  3. Explain Risk of Post-Infection Frailty
    Describe the possible long-term disease burden and the potential permanent loss of function and/or independence that could occur as a result of contracting the disease. Diabetes itself carries a significant risk for excess frailty. Stress the added effects of flu and related complications that may reduce the ability to enjoy activities and increase the burden on family members as caretakers.
  4. Emphasize Benefits of Disease Mitigation
    No vaccine is 100% effective in preventing disease. Flu vaccines reduce the severity and risk of long-term consequences of flu even 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., infants younger than six months old) or older adults with a weakened immune response to vaccines.

I hope these strategies and tips help motivate your patients to say “yes” when it comes to receiving vaccines. Check out the CDC animated infographic on the importance of vaccines for people with diabetes and printable guide you can use to share information with your patients.


We all play a part in protecting our patients from flu! Please share strategies you have successfully used to increase vaccine uptake among your patients in the comment section below.

To learn more about the benefits of vaccination in adults with chronic health conditions, including diabetes, view these additional resources:

To join the conversation and get the latest news on infectious diseases, follow NFID (@NFIDvaccines) and AADE (@AADEdiabetes) on Twitter, like NFID on Facebook, follow NFID on Instagram, join the NFID Linkedin Group, and subscribe to NFID Updates.