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Barriers remain in educating people with diabetes of their increased hepatitis B risk

Nov 06, 2014

Three years after CDC recommendations, vaccination rates still low; AADE encourages members to focus more on helping to prevent hepatitis B

Diabetes educators cite a lack of time and competing priorities during counseling sessions with patients as key barriers to educating their adult patients with diabetes about vaccination against hepatitis B, according to a new survey by the American Association of Diabetes Educators (AADE) and GSK. The survey results are highlighted in a new report,“ Hepatitis B Vaccination in Diabetes Care: Awareness, Priorities and Action among Diabetes Educators and Adults with Diabetes,” available at
People with diabetes are at increased risk for infection from hepatitis B partly due to their higher exposure to contaminated surfaces such as lancing devices and blood glucose meters, as well as lapses in infection control by healthcare workers. This, in part, led to the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) to recommend vaccination in 2011 to all unvaccinated adults ages 19-59 years, as soon as feasible after diagnosis of diabetes. Though it has been three years since the CDC’s recommendations, currently less than one-third of people with diabetes in the U.S. have been vaccinated against hepatitis B. Additionally, the survey of diabetes educators found more than half (54 percent) say their adult patients with diabetes are not aware that “as a person with diabetes, it is even more important that I get my vaccinations.”
“People with diabetes, ages 23-59 years, may have approximately a two-fold increased risk of hepatitis B infection compared to those without diabetes. Therefore, this National Diabetes Month we are reinforcing the importance of hepatitis B vaccination as a priority topic of conversation between people with diabetes and their healthcare team, including diabetes educators,” said Deborah Fillman, MS, RD, LD, CDE, Chair, AADE Foundation and Past President, AADE.

Low patient awareness about hepatitis B and vaccination 

“Hepatitis B is a health concern for people with diabetes, yet unfortunately, many are not aware that they have a higher risk of developing hepatitis B and a higher risk of death from the disease,” said Leonard Friedland, M.D., Vice President, Director Scientific Affairs and Public Health, GSK Vaccines North America. “Taking action to facilitate hepatitis B discussion among diabetes educators, providers and patients is a step we must take toward increasing vaccination rates and lowering the incidence of hepatitis B in this at-risk population.”
In the survey, diabetes educators cite a lack of awareness among their patients about the hepatitis B vaccination. Only 15 percent say their patients know about the CDC’s recommendations.

Diabetes educators face many barriers to educating patients about hepatitis B vaccination

Time is a limitation for diabetes educators. The survey found that diabetes educators prioritize educating their patients on lifestyle and behavior management versus vaccinations:
  • Seventy-two percent say setting goals and improving patient self-care habits are their priorities
  • Just seven percent say that ensuring that patients receive the recommended vaccinations is a priority they have for their patients  

Disconnect between awareness and beliefs

The survey also found a lack of awareness of the CDC’s recommendations, yet a belief that hepatitis B vaccination is an important topic to discuss with their patients.
  • The majority of respondents (52 percent) are unaware of the specific CDC recommendations
  • In fact, 74 percent say their hepatitis B vaccination education efforts have remained the same over the past three years since the CDC issued its recommendations
  • Even with the lack of awareness around the CDC recommendations, nearly 80 percent feel that it is very or somewhat important for their adult patients with diabetes to be educated about hepatitis B
  • However, most diabetes educators either do not educate their patients about hepatitis B vaccination (38 percent) or rely on primary care physicians, endocrinologists and other health providers to give patients this information (25 percent) 
“Changing the paradigm around hepatitis B education requires that all stakeholders work together to encourage vaccination,” said Joan Bardsley, MBA, RN, CDE, FAADE President, AADE. “To that end, AADE is issuing a clear call to action with our membership and others in the diabetes community to employ strategies to improve education about hepatitis B and highlight vaccinations during patient visits.”

People with diabetes at increased risk

Hepatitis B is a liver disease caused by the hepatitis B virus. The virus is 50 to 100 times more infectious than HIV. Chronic hepatitis B infection is associated with high morbidity and mortality and can cause cirrhosis and liver cancer. For the 29.1 million Americans living with diabetes, there is a higher risk of contracting hepatitis B compared to the general population due to many factors, includingthe ability of hepatitis B to survive outside the body on surfaces such as lancing devices and blood glucose meters, as well as lapses in infection control by healthcare workers.
For a link to the GSK hepatitis B and diabetes electronic press kit, click here.
About the Survey
AADE and GSK commissioned an online survey of 1,000 AADE members. The goals of the survey were to determine the level of awareness among diabetes educators of the CDC recommendations to vaccinate adults with diabetes, how diabetes educators typically inform their patients, and what level of awareness exists among AADE members’ patients about vaccinations, hepatitis B vaccination specifically.
The survey was conducted by Reckner, a national consumer opinion research company, for AADE and GSK, with financial support from GSK. The survey was fielded between August 21 and September 2, 2014. For some survey questions, respondents could answer with more than one response.
About AADE 
AADE is dedicated to empowering people with diabetes to live full and healthy lives. Diabetes educators are nurses, dietitians, pharmacists and other health professionals who work in partnership with doctors and other healthcare providers to help people manage all the daily aspects of diabetes care, from healthy eating and being active to problem solving and healthy coping. AADE was founded in 1973 and today has more than 14,000 members. 
GSK – one of the world’s leading research-based pharmaceutical and healthcare companies – is committed to improving the quality of human life by enabling people to do more, feel better and live longer. View

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