Pic by Andrea Piacquadio, Pexels

By Ross Wollen

August 26th, 2022

Experts are expecting a huge comeback for the flu this season — and they are urging Americans (and everyone else in the Northern Hemisphere) to get their flu vaccines as soon as possible.

That warning goes double for people with diabetes, who are at a starkly elevated risk of complications from the common flu.

“The scary statistics are that people with diabetes are three times more likely to be hospitalized, and four times more likely to end up in an intensive care unit (ICU),” according to Robert Gabbay, MD, PhD. “We know how to reduce that risk: That’s getting vaccinated.”

Dr. Gabbay is the chief science and medical officer at the American Diabetes Association. He was speaking last week at an expert panel that we attended on the coming flu season. Here are some takeaways for people with diabetes:

The Next Flu Season Could Be Vicious — And Early

Experts are warning that the flu could make a huge comeback in the Northern Hemisphere this fall and winter. Michael Greenberg, MD, MPH, medical head of vaccines at Sanofi North America, stated that “we anticipate a resurgence with a potentially severe impact.”

Australia has experienced its worst flu season in years, possibly due to a “perfect storm” of factors in the post-COVID landscape. It’s not easy to predict the impact of the forthcoming flu season, or even which strains of influenza will be the most prevalent, but the situation down south is one of the best data points for professional flu prognosticators.

If you think August seems a little early to be talking about flu shots, consider that Australia’s flu season peaked several months ahead of schedule, possibly because two years of social distancing and other COVID-19 mitigation measures resulted in a population with much less natural immunity than usual. Dr. Greenberg stressed that in the post-COVID landscape, “typical patterns have been upended. There’s been a tremendous amount of unpredictability.” While the pros are still projecting a late fall or winter peak to the Northern Hemisphere flu season, something similar could happen — just another reason to get a flu shot as soon as it’s available in your community.

Gabbay emphasized, “The time is now … you want to get vaccinated early, because it could be too late.”

Beware Vaccine Fatigue

We get it; Americans are sick and tired of talking about vaccines. The very successful COVID-19 vaccines have, unfortunately, become a hot-button political issue, and even many that eagerly follow public health recommendations are wearied by talk of boosters and more boosters.

Last year, flu vaccination rates were down across the board, including for those with higher risks. Luckily, relatively few Americans suffered the consequences. It was a mild flu season, possibly due to mitigation efforts intended to slow the spread of the novel coronavirus.

This year might be different. Gabbay said, “We’re worried, frankly,” that low influenza vaccine uptake could result in a lot of avoidable sickness and death.

The panel was unanimous that the medical community needs to openly acknowledge the impact of widespread vaccine fatigue. The bottom line? Vaccines work, even if you’re tired of them.

The Flu and Diabetes

While most people can fight off a bout of the flu without major health consequences, diabetes heightens the risks. According to the Centers for Disease Control, about 30 percent of patients hospitalized with flu have diabetes.

Referring to such “scary statistics,” Gabbay said that “we need to get the word out that flu is no joke.”

Flu complications are more likely in patients with elevated blood sugar levels, “but even with good blood glucose control there’s still an increased risk. So, don’t feel like you’re protected just because your condition is well managed. You still need a flu vaccine.”

Studies have shown that flu vaccines have remarkable and comprehensive beneficial effects on people with diabetes, significantly reducing hospitalizations and all-cause mortality.

And with new strains of COVID-19 causing repeated infections across the world, some experts fear a “twindemic” of flu and COVID-19 seasons peaking simultaneously. And yes, you can get the flu and COVID-19 at the same time.

It’s important to realize that this warning goes for readers with both type 1 and type 2 diabetes. The flu can spell blood sugar mayhem for anyone with diabetes, even those that are otherwise in good health.

Your diabetes educator, endocrinologist, or primary care physician has likely already stressed the importance of having a sick day plan in place. This is simply a plan of action for managing diabetes on those occasions that an illness, like the flu, makes it so much more difficult to eat and drink normally, and to use glucose-lowering medications such as insulin with confidence.

But the best defense against the flu? Get the flu vaccine as soon as it’s available.

Over 65? Get the Right Vaccine

Did you know that there are multiple flu vaccines, including more powerful vaccines for adults 65 and older?

Although these types of special vaccines have been around for years, CDC is only now officially recommending high-dose and adjuvanted flu vaccines for adults over 65.

Our expert panel repeatedly stressed that adults over the age of 65 — especially those with higher-risk conditions like diabetes — should be “demanding” the right formulation. Many Americans simply show up to a pharmacy, clinic, or workplace, and accept whatever vaccine they’re administering without a second thought. Sometimes high-risk patients end up receiving suboptimal vaccine formulations.

You should speak to your doctor about this, and make your expectations clear; otherwise, the best information on different flu vaccine types is found on the CDC website. For the upcoming 2022–2023 flu season, the CDC preferentially recommends the following three vaccines for those over 65:

• Fluzone High-Dose Quadrivalent vaccine
• Flublok Quadrivalent recombinant flu vaccine
• Fluad Quadrivalent adjuvanted flu vaccine

If you (or the patient you’re caring for) is over 65, it’s worth taking the effort to ensure that you have access to the right vaccine. However, if you can’t find any of the three above vaccines, the CDC recommends simply taking the standard adult vaccine now rather than waiting for the special vaccine later.

Racial and Socioeconomic Disparities

Sadly, there are major disparities in flu health outcomes. In the United States, Black, Hispanic, or Latino, and American Indian or Alaskan Native people are all less likely to get a flu shot in the first place, and are more likely to be hospitalized or committed to the ICU. The same is true of rural Americans in comparison to urban dwellers.

Of note, minority communities often get stuck without access to the more powerful vaccines that are now recommended for older adults.

Gary A. Puckrein, PhD, president and CEO of the National Minority Quality Forum, explained that while COVID-19 vaccination rates initially lagged in several minority groups, targeted public health messaging was able to eventually close those gaps. He feared that a similar effort may be required to get flu vaccination rates up before and during this flu season.

“If we’re going to address inequities in our healthcare system, vaccines are a great place to begin.”