What type of influenza vaccine is recommended for a patient with Diabetes Mellitus (DM) type II, high-dose or standard?

High-Dose vs. Standard Influenza Vaccination for Type II Diabetes Patients

High-dose or adjuvanted influenza vaccination is conditionally recommended for patients with Type II diabetes mellitus under age 65 who are taking immunosuppressive medications, but standard-dose influenza vaccine is appropriate for most Type II diabetes patients under age 65 who are not immunosuppressed. 1

Recommendations Based on Age and Immunosuppression Status

For Diabetes Patients ≥65 Years:

• High-dose quadrivalent inactivated influenza vaccine is recommended due to additional benefits in this age group 1
• The Centers for Disease Control and Prevention recommends preferential use of higher-dose or adjuvanted influenza vaccines for all adults aged ≥65 years 2

For Diabetes Patients <65 Years:

• Standard-dose influenza vaccine is generally appropriate for most patients with Type II diabetes who are not on immunosuppressive medications 1, 2
• For patients with diabetes who are also taking immunosuppressive medications, high-dose or adjuvanted influenza vaccination is conditionally recommended over standard-dose 1

Evidence Supporting These Recommendations

Increased Risk in Diabetes Patients:

• People with diabetes have higher rates of influenza-related complications, hospitalizations, and mortality compared to the general population 1, 3
• Influenza vaccination in people with diabetes significantly reduces influenza and diabetes-related hospital admissions 1
• In people with diabetes and cardiovascular disease, influenza vaccine has been associated with lower risk of all-cause mortality, cardiovascular mortality, and cardiovascular events 1

Vaccine Efficacy in Diabetes:

• Studies show that people with diabetes generally have appropriate humoral immune responses to vaccination 1
• Subgroup analyses of patients with diabetes support that vaccination against influenza has been effective in reducing hospital admissions during influenza epidemics 1
• A meta-analysis showed that influenza vaccination is effective in preventing clinically relevant outcomes in adults with diabetes with a number needed to treat of 60,319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively 3

Practical Considerations

Timing and Availability:

• Any influenza vaccine is preferred over no influenza vaccine, and vaccination "today" is preferred over delay 1
• If high-dose or adjuvanted influenza vaccine is not available during a patient visit when influenza vaccination is indicated, standard-dose influenza vaccine should be administered 1
• Insurance restrictions may preclude administration of high-dose or adjuvanted influenza vaccination to patients <65 years of age 1

Vaccine Types:

• High-dose influenza vaccine is a quadrivalent vaccine containing 4 times the antigen as the standard-dose vaccine 1
• The adjuvanted influenza vaccine is a standard-dose quadrivalent vaccine containing the MF59 adjuvant, which elicits a strong antigenic response 1
• Two RCTs in rheumatoid arthritis patients showed higher seroconversion rates in younger patients receiving high-dose vaccination compared to standard-dose vaccination with no safety signal 1

Special Considerations

Safety:

• The influenza vaccine contains only noninfectious viruses and cannot cause influenza or other respiratory disease 1
• The most common side effect is mild soreness at the vaccination site 1
• Individuals with chicken egg allergy may experience immediate allergic reactions 1
• Adjuvanted vaccines may be associated with greater reactogenicity, though no major safety issues have been identified 1

Contraindications:

• The vaccine should not be administered to individuals with anaphylactic hypersensitivity to chicken eggs or additional components of the influenza vaccine 1
• It is recommended not to administer the influenza vaccine to individuals known to have developed Guillain-Barré syndrome within 6 weeks of a previous influenza vaccination 1

Remember that annual influenza vaccination is strongly recommended for all patients with diabetes regardless of age, as the benefits of vaccination far outweigh any potential risks 1.