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
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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.
Article: Diabetes mellitus and liver disease[Show abstract] [Hide abstract]
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.
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ABSTRACT: The issue of association between DM and liver disease is growing all over the world. The association between DM and liver disease has relevance to diabetologists, hepatologists, and primary care physicians. Association between these two common diseases (statistical association) is well known, in addition, liver disease associated with DM can be divided into three groups: 1- Liver disease occurring as a consequence of DM : Most important is NAFLD. Vicious circle appears linking fatty liver to DM and DM to progressive liver injury. 2- DM occurring as a complication of liver disease: Hepatogenous diabetes (HD) caused by liver cirrhosis and chronic hepatitis c. 3- Liver disease occurring coincidentally with DM. The Criteria for diagnosis of DM associating liver disease are the same as for the ordinary primary diabetes, taking into consideration the clinical & laboratory differences from the primary T2 DM. In patients with compensated liver disease, HbA1c may be suitable for long term glycemic control. In those with de-compensated condition, an alternative parameter as fructosamine or frequent glucose monitoring is more suitable. Apart from the increased cardiovascular risk in patients with T2 DM and NFLD, cardiovascular and retinopathic risk is low in HD. An association between chronic HCV infection, atherosclerosis, coronary artery disease and stroke has been reported. The clinical impact of DM in a hepatic patient is of utmost importance: DM promotes fibrosis progression, affect survival by increasing the risk of hepatocellular failure & variceal bleeding, impairs SVR to antiviral therapy in patient with chronic hepatitis c, and increased incidence of HCC in subjects with HCV.