Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia: A multicenter retrospective study

Table 1 Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices vaccine recommendations for diabetic patients

Vaccine	Recommendation
IIV (IIV4 or RIV4 or LAIV)	Received every year
Tdap and Td vaccine	Tdap is received once followed by a Td booster dose every ten years
PCV (PCV151 or PCV20)	Given once to previously unimmunized diabetic adults who are 19-64 years old or unimmunized adults ≥ 65
Hepatitis B vaccine	All previously unimmunized adults 19-59 years old. Diabetic adults ≥ 60 years old
HPV vaccine	Given in two or three doses as early as 9 years old and up to 26 years old and in some cases up to 47 years old
Herpes zoster vaccine	All adults ≥ 50
Chickenpox (varicella) vaccine	Two doses with 4-8 wk interval to all previously unimmunized ≥ 13 adolescents and adult
MMR vaccine	One or two doses with 28 d interval for unimmunized adults

¹Pneumococcal vaccine 15 is followed by a 23-valent pneumococcal polysaccharide vaccine booster at least 1 year later.

IIV: Influenza vaccine; RIV: Recombinant influenza vaccine; LAIV: Live-attenuated influenza virus; Tdap: Tetanus, diphtheria, and pertussis; Td: Tetanus and diphtheria; PCV: Pneumococcal vaccine; HPV: Human papillomavirus; MMR: Measles, mumps, and rubella.

Table 2 Baseline characteristics of study participants

	Overall (n = 709)
Age (yr)
18-25	172 (24.3%)
26-35	82 (11.6%)
36-45	115 (16.2%)
46-55	177 (25.0%)
56-65	123 (17.3%)
Above 65	40 (5.6%)
Gender
Male	314 (44.3%)
Female	395 (55.7%)
HbA1C
Less than 7%	202 (28.5%)
From 7%-8%	226 (31.9%)
From 8%-10%	200 (28.2%)
More than 10	81 (11.4%)
Weight, mean ± SD	76.72 ± 19.5
Pre-existing conditions
Heart disease	101 (14.24%)
Hypertension	271 (38.22%)
Dyslipidemia	241 (33.99%)
Thyroid disease	82 (11.56%)
None	233 (32.9%)
Education level
Below primary school	36 (5.1%)
School (public education)	225 (31.73%)
Bachelor’s degree	396 (55.9%)
Post graduate degree	52 (7.3%)
Living status
City	594 (83.8%)
Village	115 (16.2%)
Monthly household income
< 4500 SAR	46 (6.5%)
4500-5999 SAR	186 (26.23%)
6000-9000 SAR	67 (9.44%)
> 9000 SAR	145 (20.45%)
Not disclosed	265 (37.37%)
Diabetes duration (yr)
< 1	89 (12.6%)
1-5	185 (26.1%)
6-10	134 (18.9%)
> 10	301 (42.5%)
Health care sector
Government	547 (77.2%)
Private	162 (22.8%)
Preference for diabetes care
Primary care centers	256 (36.1%)
Diabetes care centers	296 (41.7%)
None	157 (22.1%)
Frequency of diabetes provider visits
Monthly	263 (37.1%)
Quarterly	230 (32.4%)
Annually	207 (29.2%)
None	9 (1.3%)
Diabetes regimen
Oral mediations	246 (34.7%)
Insulin	299 (42.17%)
Insulin and oral medications	91 (12.8%)
No medications	73 (10.29%)
Number of total daily medications
0-2 medications	333 (47%)
3-4 medications	235 (33.1%)
5-9 medications	129 (18.2%)
10 medications	12 (1.7%)
Previous hospitalization due to diabetes complication
Heart attack	20 (2.82%)
Diabetic foot	27 (3.8%)
Pneumonia	74 (10.43%)
Numbness in the limbs	288 (40.62%)
Kidney disease	26 (3.66%)
Stroke	24 (3.38%)
Diabetes related vision problems	116 (16.36%)
Hepatitis	10 (1.41%)
Shingles	7 (0.98%)
Erectile dysfunction	20 (2.82%)
Previous depression diagnosis	138 (19.46%)

HbA1C: Hemoglobin A1c; SAR: Saudi Arabian Riyal.

Table 3 Barriers to vaccination adherence reported by non-vaccinated patients with diabetes mellitus

Barrier	Participants, n (%)
I do not know the importance of these vaccines for diabetes	21 (29.57)
Fear of side effects	20 (28.16)
The vaccines were not suggested by the doctor	11 (15.49)
I think the vaccine is not important	10 (14.08)
Not educated about the importance of vaccines by the doctor	6 (8.45)
Lack of vaccine	2 (2.81)
Reason not disclosed	4 (5.63)