Risk and impact of herpes zoster on patients with diabetes: A population-based study, 2009–2014

Abstract

Aims: This study was designed to assess the impact of diabetes on the risk and severity of herpes zoster (HZ), and the impact of HZ on diabetes. It focused primarily on immunocompetent patients aged ≥ 50 years who would be eligible for preventive vaccination.Methods: Using population and healthcare databases of Valencia Region (Spain), a retrospective cohort of all subjects ≥ 50 years was followed up between 2009 and 2014. HZ and diabetes were defined using ICD-9 codes. We compared the incidence of HZ between non-diabetes and diabetes groups and healthcare resource consumption due to HZ in the 6 months following HZ diagnosis using different statistical generalized linear models (GLM). We also compared resources consumption due to diabetes treatment and haemoglobinA1c(HbA1c) levels before and after HZ.Results: The cohort consisted of 2,289,485 individuals ≥ 50 years old, 397,940 of whom had diabetes. HZ incidence rate was 9.3 cases/1000 persons with diabetes-year (95% CI: 9.1–9.4). Incidence increased with age in all groups. The risk of HZ increased in the diabetes group compared to the non-diabetes group (RR 1.2, 95% credibility interval [CrI] 1.17–1.22). Patients with diabetes utilized more health care resources due to their HZ episodes than patients without diabetes. In 24% of well controlled patients with diabetes (HbA1C levels ≤ 6.5%), HbA1C increased after HZ.Conclusions: Diabetes increased by 20% the risk of HZ. HZ contributed to the deterioration of glycaemic control and higher healthcare resource consumption in people with diabetes, becoming a priority population for HZ immunization.

Herpes Zoster Infection as a Presentation for Hidden Diabetes Mellitus

“…The incidence of undiagnosed DM is high among patients with HZ due to impairment of immunity in different types of DM [5,[10][11][12]. The innate immune responses by polymorphonuclear cells and monocytes/macrophages are lower in patients with DM, with inadequate cutaneous reaction to the interferon-alpha which is important to cease the VZV spread in the skin [1,[5][6].…”

“…HZ shows an aggressive course in patients with DM, with higher health-related resource consumption, poor glycemic control, and reduced quality of life. This will reflect negatively on the number of outpatient visits, hospitalizations, and medication for diabetes after the HZ episode, as well as an increase in HbA1c levels [3,6].…”

“…Further protection for affected persons may be acquired by vaccination against HZ/PHN to reinforce the CMI against the latent VZV, impeding its reactivation and the associated complications. The vaccine prevents effectively against HZ and PHN and also reduces the severity of the HZ symptoms [2,6,19].…”

“…The incidence of undiagnosed diabetes mellitus (DM) is high among HZ patients, which may be due to impairment of CMI, phagocytosis, and opsonization, with intact humoral immunity [5][6]. Although HZ deteriorates glycemic control, the latter does not correlate with the severity of impaired CMI [6][7].…”

“…The highly prevalent DM increased the risk of HZ by 20%; yet, the current guidelines do not recommend DM screening in HZ [6,8]. However, given such a high prevalence and the quiescent DM picture in HZ patients, glucose levels must be screened at the time of diagnosis of HZ and repeated one week later to exclude stress hyperglycemia [5,[9][10].…”