New Study Seeks to Increase Vaccination Rate in Patients with Type 2 Diabetes

A new study from the American Diabetes Association’s (ADA) 81st Scientific Sessions urged transparency in regard to the efficacy and benefits of the influenza vaccine for young patients with type 2 diabetes(T2D).

The study, lead by Dr. Jennifer Apsan, investigated the multitude of reasons for vaccine hesitancy in diabetic patients.

“Our goal was to try to get a sense in our diabetes clinic, both to look at our vaccination rates in our type 1 and type 2 diabetes patients, and also to better understand vaccine hesitancy as is relates to flu vaccinations. It’s really to try to better ourselves,” Apsan said.

Despite most children having manageable reaction to the flu, Apsan did note that patients with diabetes still experienced complications.

“We know that there are significant comorbidities from influenza itself, whether that be sinusitis, bronchitis, onychitis median. We know that all those comorbidities that can come about from influenza infection are worse in the diabetes population”

Despite the changes in approaches to vaccinations from both medical and patient perspectives caused by the COVID-19 pandemic, Apsan stated that vaccinations among young patients had been a concern for years prior.

Additionally, while organizations such as the American Diabetes Association have promoted influenza vaccinations in patients from 6 months to 18 years old, the national vaccination rate had only risen to 49% in those groups in recent years, nearly 20% less than the goal Apsan and colleagues advocated for in the study.

The participant group was comprised of 64 patients, ages 2-20 years, from various diabetes clinics in New York. Participants or their parents/guardians were surveyed between December 2019 and March 2020.

The surveyed asked if the patient had received or was planning to receive a flu vaccine. If the responses indicated they had refused a vaccine, they were then asked why they had refused. All patients were asked if they would accept a vaccination if one were available at the diabetes clinics they frequented.

Overall, 57% of all patients in the study received an influenza vaccine in the 2019-2020 season, while 13% of patients said they intended to receive a vaccine.

The responses from participants who did not get vaccinated were more varied.

The investigators recorded that 27% of patients answered that they did not wish to receive a vaccination. The most common reasons for refusal included patient preference (31%), disbelief in efficacy (21%), concerns for side effects (21%) and “too busy” (10.5%)

While there was a significant decrease in vaccinations in the youngest and oldest patients in the study, patients in the 10-15 years old range had the highest vaccination rate at 70%.

“We saw a significant drop in our youngest population (1-5 years old) and our oldest teenagers (15-20 years old). A lot of this is left to speculation, but based people’s qualitative answers, I think it is fair to say in babies ages 2 to 5 years old, the hesitancy is just at it’s max,” Apsan said. “People are anxious about things. Children are small, they’re not able to communicate if they’re have side effects. I think that’s certainly part of the picture for the very young children”

Apsan speculated that some older patients simply did not want to have extra medical care, and perhaps did not consider the “big picture” and the impact of vaccinations on good diabetes control.

However, 70% of all patients surveyed, regardless of whether they were vaccinated or not, expressed that if a vaccination was offered in their diabetes clinic, they would be interested in receiving it.

Apsan and colleagues considered vaccine availability in diabetes clinics to be an important change in normalizing vaccinations. Additionally, they say that various clinics in the New York area have had greater access to vaccines in the past year.

In regard to participants who refused a vaccine, investigators called for a greater understanding in the common hesitations among patients, and for clearer communication between health care professionals and diabetes patients.

“We really have the opportunity to form lifelong relationships with these people,” Apsan said. “I think a lot of it is just being able to be comfortable and be a little more trusting of the medical community, and to keep emphasizing over and over when new data comes out about both vaccine side effect profiles and vaccine efficacy.”

The study, "Understanding Attitudes towards Influenza Vaccination among Children with Diabetes in a NYC Hospital", was published online in ADA.