From the Guidelines
Patients with diabetes are not automatically considered immunocompromised, though they may have impaired immune function, and their immune status should be assessed on a case-by-case basis. Diabetes can affect the immune system by impairing neutrophil function, cellular immunity, and complement activation, which can increase susceptibility to certain infections, as noted in studies such as 1 and 1. However, diabetes alone does not classify someone as immunocompromised in the same way as conditions like HIV/AIDS, organ transplantation, or chemotherapy treatment would. The degree of immune dysfunction in diabetes correlates with glycemic control - patients with well-controlled blood sugar levels typically have better immune function than those with poor control, as discussed in 1 and 1.
Key Considerations
- Patients with diabetes should maintain good glycemic control through appropriate medication, diet, and exercise to support optimal immune function.
- They should also follow recommended vaccination schedules, such as annual influenza vaccination for all diabetic patients ≥6 months of age, as recommended by 1 and 1.
- Practice good hygiene and seek prompt medical attention for infections, as infections may progress more rapidly and be more severe in diabetic patients.
- Regular monitoring of blood glucose levels and adherence to diabetes management plans are essential for maintaining both metabolic health and immune function, as emphasized in 1 and 1.
Vaccination Recommendations
- Annually provide an influenza vaccine to all diabetic patients ≥6 months of age, as stated in 1 and 1.
- Administer pneumococcal polysaccharide vaccine to all diabetic patients ≥2 years of age, with a one-time revaccination recommended for individuals ≥65 years of age who have been immunized ≥5 years ago, as noted in 1 and 1.
- Consider administering hepatitis B vaccination to unvaccinated adults with diabetes who are aged ≥60 years, as suggested in 1 and 1.
By prioritizing good glycemic control, following vaccination schedules, and practicing good hygiene, patients with diabetes can reduce their risk of infections and maintain optimal immune function, ultimately improving their morbidity, mortality, and quality of life outcomes, as supported by the highest quality and most recent study, 1.
From the Research
Immunocompromised State in Diabetes
- Diabetes mellitus is associated with an immunocompromised state, making patients more susceptible to various types of infections 2, 3, 4.
- The immunocompromised state in diabetes is caused by uncontrolled hyperglycemia, which impairs overall immunity via various mechanistic pathways 2.
- Hyperglycemia favors immune dysfunction, including damage to neutrophil function, depression of the antioxidant system, and humoral immunity 3.
Infection Susceptibility in Diabetes
- Patients with diabetes have a higher susceptibility to infectious diseases, including skin, mucous membrane, soft tissue, urinary tract, respiratory tract, and surgical and/or hospital-associated infections 2, 3, 4.
- Specific microbes are associated with each type of infection, and their presence indicates the type of infection 2.
- Diabetic-foot infections are a common complication in diabetic patients 2.
Vaccination Recommendations
- Immunization with anti-pneumococcal and influenza vaccines is recommended to reduce hospitalizations, deaths, and medical expenses in diabetic patients 3.
- Adherence to guidelines for hepatitis B, pneumococcal, and influenza vaccination is crucial in patients with diabetes, but nonadherence is common 5.
Management of Immunocompromised Patients
- Immunocompromised patients, including those with diabetes, require special consideration and management to prevent and treat infections 6.
- Healthcare providers should be aware of the specific infectious risks and considerations for immunocompromised patients and take steps to manage them effectively 6.