Health-care professional’s attitude, beliefs and perceived potential barriers for recommended adult immunization practices in patients with type-2 diabetes mellitus

Background: Immunization coverage remains very low among adults. Vaccine preventable diseases (VPDs) may have an unpredictable course in diabetes mellitus (DM) owing to their altered immune functions. The objective of the study was to analyse the knowledge, attitude, practices and behaviour of the healthcare professionals (HCPs) regarding the pneumococcal, influenza and hepatitis B vaccination in patients of type-2 DM.Methods: This was a community based, cross-sectional study focusing on HCPs who were involved in diabetic care and were aware about recommended guidelines of adult immunization program. 100 HCPs completed this survey which embraced various parameters involved in vaccine uptake.Results: Females constituted 34% of the participating HCPs. The HCPs with qualification of MBBS and MD were 51% and 49% respectively. MD HCPs were routinely vaccinating DM patient more than MBBS ones which was statistically significant. Difficulty in identifying patients eligible for vaccination was perceived by 53% of HCPs. Vaccination was believed to be more important in children than adults by 63% HCPs and 93% agreed that vaccination provided protection against VPDs. Perceived as barriers for vaccination were: urgent concerns of the patients (79%), lack of time for explaining (49%), vaccine safety (60%), cost of vaccine (58%), lack of records (65%), lack of recall system (62%), lack of educational material for patients (83%), lack of training for HCPs (75%) and lack of ‘standing orders’ (84%).Conclusions: Despite recommendations for adult immunization, there are many substantial lacunae in knowledge and practice among HCPs resulting in low immunization coverage. A structured approach encompassing education and training, identification and elimination of potential barriers and improving infrastructure and leadership is the need to curb the mortality and morbidity associated with VPDs in diabetics

Vitamin D levels and tumor necrosis factor-α activity in newly diagnosed patients with type 2 diabetes mellitus: An exploratory study in North-East India

Background: Diabetes poses a global threat, leading to hospitalizations and premature death if not managed properly. It involves tumor necrosis factor-α (TNF-α), an inflammatory cytokine, which binds to TNF-α receptor-1, triggering sphingomyelinase, and ceramide production. Vitamin D acts as an anti-inflammatory agent, reducing inflammatory cytokines and proinflammatory cell growth, and benefiting diabetes mellitus (DM). Aims and Objectives: The primary objective was to compare serum Vitamin D and TNF-α levels in diabetics and non-diabetics. The secondary objective was to explore Vitamin D and TNF-α correlation in newly diagnosed type 2 diabetes. Materials and Methods: A case–control study involved 92 subjects in each group. Data included demographics, clinical assessments, glycemic parameters, Vitamin D, and TNF-α. Statistical analysis used student’s t-test and Pearson correlation (P<0.05). Results: The cohort comprised 34 females (36.96%) and 58 males (63.04%). Cases had significantly higher glycemic levels: FBG (247.2±53.92 mg/dL vs. 91.45±16.64 mg/dL), postprandial plasma glucose (319.7±72.08 mg/dL vs. 111.3±21.76 mg/dL), and glycated hemoglobin (HbA1c) (10.39±2.41% vs. 5.43±0.48%). Mean serum Vitamin D in cases (22.63 ng/mL) was significantly lower than controls (58.15 ng/mL), and mean TNF-α in cases (5.01 pg/mL) was higher than controls (4.63 pg/mL, P<0.0001). HbA1c negatively correlated with serum Vitamin D (r=−0.7461) and positively with TNF-α (r=0.7831). Vitamin D correlated negatively with TNF-α (r=−0.6481). Conclusion: The study revealed lower serum Vitamin D and higher TNF-α levels in cases, with a significant inverse association. It also found an inverse link between Vitamin D and HbA1c and a strong positive correlation between HbA1c and TNF-α. Recognizing Vitamin D and TNF-α’s diagnostic significance promises innovative strategies for managing type 2 DM