Perspectives on Diabetes Care

Diabetes and Hepatitis B

Apr 13, 2015, 20:00 PM

I recently attended a regional diabetes gathering to learn what has been happening with certified diabetes educators in upstate South Carolina. I also attended the gathering to refresh my memory on the 2015 American Diabetes Association (ADA) Standards of Medical Care. It was a great review by a medical science liaison. I will be honest – I spent most of the time reflecting on the new pneumococcal recommendations. The Centers of Disease Control (CDC) and Advisory Committee on Immunization Practices (ACIP) provides the annual schedule for childhood and adult immunizations. When thinking about the constant changes in immunizations, I wanted to write about the hepatitis B virus and its recommendations.

In 2011, the ACIP voted 12-2 to recommend the hepatitis B virus immunizations among patients with diabetes. The series is recommended for any patient 19 to 59 years of age with diabetes, whereas it is the physician’s choice to vaccinate a patient with diabetes and older than 60 years. For patients over the age of 60 years, the physician should determine the patient’s risk of contracting hepatitis B since the vaccination’s effectiveness decreases with age. In addition, patients living in nursing homes may be at higher risk of contracting hepatitis B virus, than someone living along at home. Some certified diabetes educators may have a difficult time with physicians accepting this recommendation. Patients may even look puzzled when mentioning the hepatitis B virus immunization as a preventative strategy against the disease. Explaining why patients with diabetes are at a high risk of hepatitis B may improve rates of immunizations among this special population.

First, blood or other bodily fluids is the common source of hepatitis B transmission. If an infected patient shares diabetic supplies, such as needles, pens, syringes, then she or he is putting other individuals at risk of transmission and infection. All patients should be educated on methods of transmission and strongly encouraged not to share any diabetes supply item. Second, people may think hepatitis is only an active infection of the liver. Yes – there is acute infection, but most often, people develop chronic hepatitis B infection, requiring indefinite treatment with anti-virals. Furthermore, liver complications can develop from hepatitis B. Third, the best method of prevention is the hepatitis B virus vaccination series. Patients should be educated about receiving the three injections over a 6 month period. According to the CDC, the injections can be given intramuscularly at 0, 1, and 6 month. Patients can be informed that this series is lifelong and will not require re-vaccination. Additional information can be found from the CDC.

I hope this information is helpful. Do not forget to speak with patients about hepatitis as May is Hepatitis Awareness Month.