Shingles and Diabetes: Connection, Impact and Prevention

Living with diabetes comes with its share of challenges, impacting various aspects of daily life. Managing blood sugar levels, a complex medication regimen, and dietary restrictions are some of the hurdles people with diabetes face.¹

While managing diabetes can be challenging, you should not evade learning about its impact or how it can attract other diseases.¹

More and more evidence show that diabetes increases the risk of developing herpes zoster, commonly known as shingles.²

Let’s explore the relationship between the two conditions and its implications.

What is Diabetes?

Diabetes is a chronic health condition that affects how your body processes food into energy. It's characterized by elevated blood sugar due to insufficient insulin production or ineffective use.^3,4

There are 2 types of diabetes, Type 1 (lack of insulin) and Type 2 (insulin resistance).⁴

Type 1 Diabetes

This happens when the body's defense system attacks itself by mistake. It can cause serious problems like heart disease, kidney troubles, and eyesight issues if not controlled. ⁴

Type 2 Diabetes

In this situation, the body has trouble using insulin properly and keeping blood sugar in check. Many people with diabetes have type 2. It usually starts slowly and is often found in adults, but now even kids, teenagers, and young adults can get it. ⁴

Effects of Diabetes on the Immune System

Hyperglycemia in diabetes is thought to cause dysfunction of the immune response, which fails to control the spread of invading pathogens in diabetic subjects.⁵

This means when a person has diabetes and their blood sugar levels are too high (hyperglycemia), it can make their immune system not work properly.

Consequently, individuals with diabetes become more susceptible to infections. ⁵

How Diabetes Increases Your Risk for Shingles?

Diabetes is a chronic condition that raises the risk of various diseases affecting organs like the brain, kidneys, heart, and eyes due to damage to blood vessels. It also makes individuals more vulnerable to infections.⁵

Since a weak immune system increases the risk of shingles, a person with diabetes is more vulnerable. Diabetes increases the risk of developing herpes zoster by 40%. ^6,7

Impact of Shingles on Diabetics

Herpes zoster can pose significant challenges for individuals with diabetes.²

Effect on Glycaemic Control:

• Herpes zoster can worsen glycaemic control (the optimal serum glucose concentration) in diabetic patients.⁸

In a study, around 24% of well-controlled diabetic patients experienced a decline in their glycaemic control, measured by HbA1c (a blood test measuring the average blood sugar or glucose level), after getting a herpes zoster infection.⁸

Complications and Severity:

• Since diabetes affects the immune system⁵, the symptoms of shingles could be severe.²

Interference with Diabetes Management:

• Diabetic patients may experience difficulty controlling their blood sugar after shingles. Additionally, they are more likely to be hospitalized for other health issues during this time.²

What is Shingles (Herpes Zoster)

Shingles, also known as herpes zoster, is an infection that causes a painful skin rash with blisters. Varicella-zoster virus causes shingles, the same virus that causes chickenpox. After a person has had chickenpox, the virus remains dormant in their body and can reactivate later in life, leading to shingles.⁹

A weak immune system increases the risk of shingles and hence is more common in older adults, and the risk of developing the condition increases with age.¹⁰

A seroprevalence study in Indian subjects indicated that by the age of 50 years, more than 90% had the varicella-zoster virus in their body, making them vulnerable to shingles.^11,12

Shingles Symptoms

Prior to the rash's appearance, individuals may experience pain, itching, or tingling in the affected area, often occurring several days in advance. Some people may also develop a fever before the rash emerges.¹³

Common symptoms:

• Rash, usually painful and itchy, comprises of blisters that usually develop scabs within a span of 7 to 10 days, ultimately resolving completely over a period of 2 to 4 weeks.13
• The rash most commonly occurs in a single stripe on the left or the right side of the body.9
• Shingles rash can occur on one side of the face, which may affect the eye and cause vision loss.13

Other symptoms may include¹³:

• Headache
• Chills
• Upset stomach

Shingles Prevention

Vaccination can help prevent shingles.¹⁴ Shingles vaccination is recommended for adults 50 years and older. ^15,16

Disclaimer: A public awareness initiative by GlaxoSmithKline Pharmaceuticals Limited, Dr. Annie Besant Road, Worli, Mumbai 400 030, India. Information appearing in this material is for general awareness only. Nothing contained in this material constitutes medical advice. Please consult your doctor for medical advice or any question or concern you may have regarding your condition. Please consult your doctor for the complete list of vaccine-preventable diseases and the complete vaccination schedule for each disease.All scientific information is validated, for details write to us on askus@gsk.com.

CL Code: NP-IN-HZU-WCNT-230018 DoP Sep 2023

References:

1. 10 Tips for coping with diabetes distress [Internet]. Cdc.gov. 2022 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetesdistress.html
2. Papagianni M, Metallidis S, Tziomalos K. Herpes Zoster and Diabetes Mellitus: A Review. Diabetes Ther. 2018 Apr;9(2):545-550.
3. CDC. What is diabetes? [Internet]. Centers for Disease Control and Prevention. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/diabetes/basics/diabetes.html
4. Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 2020;16(5):442-449.
5. Batram M, Witte J, Schwarz M, Hain J, et al. Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007-2018. Dermatol Ther (Heidelb). 2021 Jun;11(3):1009-1026.
6. Marra F et al. Open Forum Infect Dis. 2020;7:1-8.
7. Huang CT, Lee CY, Sung HY, et al. Association Between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 2022 Jan 18;107(2):586-597.
8. Muñoz-Quiles C, López-Lacort M, Ampudia-Blasco FJ, Díez-Domingo J. Risk and impact of herpes zoster on patients with diabetes: A population-based study, 2009–2014. Hum Vaccin Immunother [Internet]. 2017 [cited 2023 Sep 11];13(11):2606–11. [Accessed 2023 Sep 11] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798425/
9. Clinical overview [Internet]. Cdc.gov. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/shingles/hcp/clinical-overview.html
10. Five things you should know about shingles [Internet]. Cdc.gov. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/shingles/5-things-you-should-know.html
11. Lokeshwar MR, Agrawal A, Subbarao SD, Chakraborty MS, Av RP, Weil J, et al. Age related seroprevalence of antibodies to varicella in India. Indian Pediatr [Internet]. 2000 [cited 2023 Sep 11];37(7). [Accessed 2023 Sep 11] Available at: https://pubmed.ncbi.nlm.nih.gov/10906803/
12. GSK launches Shingrix in India- A vaccine for the prevention of shingles in adults aged 50 years and above [Internet]. Gsk.com. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://india-pharma.gsk.com/en-in/media/press-releases/gsk-launches-shingrix-in-india-a-vaccine-for-the-prevention-of-shingles-in-adults-aged-50-years-and-above/
13. Signs and symptoms [Internet]. Cdc.gov. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/shingles/about/symptoms.html
14. Prevention and treatment [Internet]. Cdc.gov. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://cdc.gov/shingles/about/treatment.html
15. CDC. Shingles vaccination [Internet]. Centers for Disease Control and Prevention. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html
16. Adult immunization schedule – healthcare providers [Internet]. Cdc.gov. 2023 [cited 2023 Sep 11]. [Accessed 2023 Sep 11] Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html