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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia: A multicenter retrospective study
Saleh Fahad Alqifari, Aya K Esmail, Dalal M Alarifi, Ghalya Y Alsuliman, Maram M Alhati, May R Mutlaq, Mohammed Aldhaeefi, Shaden A Alshuaibi, Palanisamy Amirthalingam, Abrar Abdallah, Afaf S Wasel, Heba R Hamad, Shoroq Alamin, Tasneem H Atia, Tariq Alqahtani
Saleh Fahad Alqifari, Palanisamy Amirthalingam, Department of Pharmacy Practice, University of Tabuk, Tabuk 71491, Saudi Arabia
Aya K Esmail, Dalal M Alarifi, Ghalya Y Alsuliman, Maram M Alhati, Shaden A Alshuaibi, Abrar Abdallah, Afaf S Wasel, Heba R Hamad, Shoroq Alamin, Tasneem H Atia, Department of Clinical Sciences, Sulaiman Alrajhi University, Qassim 52726, Saudi Arabia
May R Mutlaq, Department of Family Medicine, International Medical Center, Jeddah 23214, Saudi Arabia
Mohammed Aldhaeefi, Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC 20059, United States
Tariq Alqahtani, Department of Pharmacology, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
Author contributions: Alqifari SF contributed to the conceptualization and project administration; Alqifari SF, Mutlaq MR, and Aldhaeefi M were involved in the methodology of this study; Alqifari SF, Amirthalingam P, and Alqahtani T analysed data; Alqifari SF, Esmail AK, Alarifi DM, Alsuliman GY, Alhati MM, Mutlaq MR, and Alshuaibi SA participated in the data interpretation; Alqifari SF, Esmail AK, Alarifi DM, Alsuliman GY, Alhati MM, Mutlaq MR, and Alshuaibi SA contributed to the writing - original draft preparation; Alqifari SF, Esmail AK, Mutlaq MR, Aldhaeefi M, Abdallah A, Wasel AS, Hamad HR, Alamin S, Atia TH, Alqahtani T took part in the writing - review and editing; Alqifari SF and Amirthalingam P were involved in the visualization; Alqifari SF, Mutlaq MR, Aldhaeefi M, and Alqahtani T participated in the supervision; and all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki. The study protocol (607-43-6007) was granted IRB approval by the Regional Research Ethics Committee - Ministry of Health, Saudi Arabia.
Informed consent statement: Informed consents have been obtained on first page of the online questionnaire. A clear information of the purpose of the study, participants rights during completing the questionnaire and withdrawal at any stage were provided. Only those who agreed to participate were able to complete the online survey.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Saleh Fahad Alqifari, PharmD, Assistant Professor, Chief Pharmacist, Department of Pharmacy Practice, University of Tabuk, King Faisal Road, Tabuk 71491, Saudi Arabia. salqifari@ut.edu.sa
Received: November 8, 2023
Peer-review started: November 8, 2023
First decision: December 26, 2023
Revised: January 3, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 15, 2024
ARTICLE HIGHLIGHTS
Research background
Diabetes constitutes a major risk factor for all types of infection due to deficiency in immune system. Those infections are not only frequent, but also have more risk of progression into severe presentation and poorer response to treatment. Enhancing immunity through vaccinations helps protect against potentially severe complications of such infections. The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) issued immunization recommendations to protect this patient population.
Research motivation
Data on adherence to immunization recommendations in patients with diabetes mellitus (DM) in Saudi Arabia is scarce. Shedding some light on immunization practices in this patient group should aid healthcare providers and decision-makers in optimizing DM preventative care in Saudi Arabia.
Research objectives
This retrospective multicenter study objectives include assessing the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and identifying the factors associated with the vaccine adherence rate.
Research methods
This is a retrospective study conducted in two phases to collect data regarding immunization rate of diabetic patients in Saudi Arabia. Data from 1000 eligible patient were gathered in phase I through chart review from 13 diabetes care centers. In phase II of the study, 709 out of the 1000 patients were enrolled through answering an online survey.
Research results
After data analysis, 10.01% (n = 71) of participants had never received any vaccine. The number of vaccinated diabetic patient with coronavirus disease 2019 (COVID-19) vaccine was 85.89% (n = 609), and annual influenza, 34.83% (n = 247), which is higher compared to other vaccinations. Multiple factors were significantly related to the rate of vaccinations among patients with diabetes including site of care, income level, DM-related hospitalization history, residency site, hemoglobin A1c (HbA1c) level, and health sector type. Lacking enough knowledge regarding the importance of immunizations and concerns regarding vaccine side effects were major barriers for receiving vaccines. This highlights the importance of conducting larger studies to explore other risk factors that may encourage adherence to CDC/ACIP vaccine recommendations.
Research conclusions
Although patients with diabetes are more prone to developing all types of infections, their overall vaccination rate is still suboptimal. Adults with diabetes in Saudi Arabia have higher rate of COVID-19 and annual influenza vaccines compared to other vaccines recommended by CDC/ACIP. Among patients with diabetes, factors significantly influence the decision of vaccination include recommendations provided by family physicians or specialists, the site of care, income level, DM-related hospitalization history, residency site, HbA1c level, and health sector where care is being provided.
Research perspectives
This signifies the need for large-scale research to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.
