Another Shot to Protect People With Diabetes: Add Hepatitis B Vaccination to the Checklist

Corresponding author: M. Sue Kirkman, .
Diabetes care (Impact Factor: 8.42). 05/2012; 35(5):941-2. DOI: 10.2337/dc12-0164
Source: PubMed
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    ABSTRACT: Adults with diabetes, heart disease, and chronic lung diseases are susceptible to increased morbidity and mortality from infectious diseases. Utilization of vaccinations for disease prevention in this population is low. The Centers for Disease Control and Prevention provide vaccine guidance for patients with these conditions and the schedules are published annually. Patients with chronic conditions are advised to receive annual inactivated influenza vaccinations and the pneumococcal polysaccharide vaccine. An additional dose of pneumococcal polysaccharide vaccine is recommended if the first dose was administered before the age of 65 and 5 years have elapsed since the first dose. The hepatitis B vaccine series was recently added to the vaccine schedule for patients with diabetes because of the increased incidence of infection and poor disease outcomes. All adults are recommended to receive the tetanus, diphtheria, and acellular pertussis vaccine in place of a routine tetanus diphtheria booster. In addition, all adults older than 60 years should be vaccinated against herpes zoster. Strategies to increase immunization rates utilize multiple approaches; however, direct recommendations from healthcare providers are more successful at increasing patient engagement and compliance. Immunization counseling should be a priority and standard of care in the office.
    Osteopathic Family Physician 07/2013; 5(4):169–174. DOI:10.1016/j.osfp.2013.02.001
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    ABSTRACT: About 30% of patients with cirrhosis have diabetes mellitus (DM). It is still debated whether type 2 DM in the absence of obesity and hypertriglyceridemia is a risk factor for chronic liver disease. DM that develops as a complication of cirrhosis is known as “hepatogenous diabetes”. Insulin resistance in muscle and adipose tissues and hyperinsulinemia seem to be the patho-physiologic bases of diabetes in liver disease. An impaired response of the islet β-cells of the pancreas and hepatic insulin resistance are also contributory factors. Non-alcoholic fatty liver disease, alcoholic cirrhosis, chronic hepatitis C (CHC) and hepato-carcinoma are more frequently associated with DM. Insulin resistance increases the likelihood of failure to respond to treatment in patients with CHC and boosts the progression of fibrosis. DM in cirrhotic patients may be subclinical. Hepatogenous diabetes is clinically different from type 2 DM: it is less frequently associated with microangiopathy and patients more often suffer complications of cirrhosis. DM increases the mortality of cirrhotic patients. Treatment of the diabetes is complex because of the liver damage and the hepatotoxicity of many oral hypoglycemic drugs.
    Giornale Italiano di Diabetologia e Metabolismo 03/2015; 35(1):16-21.


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