Vaccination in diabetes: an inter-society perspective

Abstract

Vaccination is one of the preventive interventions with the greatest impact in people with diabetes, in whom vaccine-preventable infections show higher incidence and severity¹. Its indication, however, extends beyond the metabolic condition: fewer than 20% have diabetes alone, and most also present cardiovascular, renal or age-related conditions, for which each specialty issues valid and specific recommendations¹. These recommendations must be integrated into a single schedule, prioritized and prescribed. It is along this path, from the available recommendation to the effective prescription, that the process breaks down.

In an Argentine population survey of 32,365 adults, coverage was 51.6% for influenza and 16.2% for pneumococcus²; among adults assessed in 2020 in three regions of the country, 37.7% and 24.7%, respectively³. Lack of awareness of the indicated vaccines and the absence of prescription account for the largest share of missed opportunities, whereas active refusal is a minority⁴. The gap is therefore explained neither by vaccine unavailability nor by patient refusal.

The effect attributable to the physician has been quantified: with a favorable physician attitude, the probability of vaccination reaches 90% in willing patients and 87% in hesitant ones, and falls to 7% when a negative attitude is shared by both⁴. In the cohort cited above, coverage rose to 71.7% and 59% in the subgroup with a recorded indication for both vaccines³. Here the internal medicine physician fulfils a function that does not compete with that of the other specialties but rather depends on them: receiving recommendations issued in parallel, converting them into a single schedule for an individual patient, and sustaining its fulfilment throughout longitudinal follow-up.

The transmission of accurate information is, on its own, insufficient to increase vaccination rates⁴. Evidence supports structured communication as a clinical competence with a measurable effect: frameworks such as ASPIRE —presenting an explicit recommendation, proactively addressing safety concerns, responding and empathizing— and motivational interviewing act on the individual determinants of the decision and improve vaccine acceptance⁴. Their effectiveness depends on trust and on continuity of the care relationship, conditions inherent to the longitudinal follow-up provided by the internal medicine physician. Clinical communication thus constitutes the mechanism that turns an indication into an accepted decision, and therein lies the greatest margin for reducing the vaccination coverage gap.