People with underlying conditions, such as type 1 or type 2 diabetes, are more likely to become severely ill or die from contracting the SARS-CoV-2 virus that causes COVID-19. According to the Centers for Disease Control and Prevention (CDC), these individuals who develop COVID-19 may require a hospital stay, a ventilator to improve breathing, and intensive care unit services.

Because health care professionals are considered trusted sources of information, talking with patients who have diabetes about the importance of receiving the COVID-19 vaccine may influence behavior. 

Tackling Vaccine Hesitancy

Because widespread vaccination is critical to stopping the pandemic, health care professionals should spend time addressing any feelings of hesitancy or worry in their patients with diabetes. Talking with your patients is important because vaccine endorsement by a trusted health care professional could potentially motivate some people to get vaccinated.

Rather than lecturing patients, health care professionals should engage with them in open, nonjudgmental, two-way conversations about why they feel hesitant. Health care professionals should also validate patients’ concerns or fears and correct any false beliefs or misperceptions. If comfortable, you may want to tell your patients about your reasons for getting vaccinated.

“A trusted health care professional answering a patient’s questions and offering reassurance is one of the most compelling ways for people to make the decision to get vaccinated,” said Barney Graham, MD, PhD, deputy director in the National Institute of Allergy and Infectious Diseases (NIAID)’s Vaccine Research Center. “Let patients know that the risk of infection is still ongoing. The consequences of infection can include a risk of death in 1–2% of those who are not vaccinated, upwards of 10% of unvaccinated people being hospitalized, and about 20% of unvaccinated people experiencing chronic post-COVID symptoms, which could be even higher in people with diabetes. These do not compare to the temporary side effects of vaccination that may last a day or two, or the extremely rare adverse reactions from vaccination that are almost always readily treatable.”

Critical Conversations

Conversations about the COVID-19 vaccine should be clear, informative, and easy for patients to understand. Health care professionals should start by strongly encouraging all patients with diabetes to receive the COVID-19 vaccine. All three vaccines approved by the U.S. Food and Drug Administration (FDA)—one receiving full approval (Pfizer/BioNTech) and two approved for emergency use (Moderna and Johnson & Johnson)—have been rigorously tested and found to be safe for nearly everyone, including people with diabetes.

“It is important for health care professionals to ask patients whether they are or have been infected with SARS-CoV-2,” said Dr. Graham. “Fortunately, there are antiviral drugs and therapeutic monoclonal antibodies that are effective for treating people with mild to moderate COVID-19 and preventing them from progressing to hospitalization. The therapeutic antibodies are available under Emergency Use Authorization for people over 65 years old or those over 12 years old with a risk factor, so people with diabetes should qualify for treatment.” 

Benefits and Side Effects of Vaccination

The benefits of receiving the COVID-19 vaccine far outweigh the side effects. The vaccine has been shown in multiple clinical trials across the world to be highly effective at preventing COVID-related hospital stays and death. In addition, vaccination may help some patients with diabetes return to school or work, resume socializing with loved ones and friends, and reengage in activities that have been limited since the start of the pandemic. This could include things like attending an outdoor gathering with family and friends, seeing a movie, or traveling.

“It is particularly important for patients with diabetes to be vaccinated because diabetes is a risk factor for severe COVID-19 disease and for having a bad outcome,” said Dr. Graham, adding that the vaccines authorized for emergency use have a very low frequency of side effects. 

Dr. Graham also noted that the consequences of SARS-CoV-2 virus infection are much more serious than any side effects from the vaccines, which have now been given to hundreds of millions of people. 

“The decision one has to make is not whether to take the vaccine or not; it is whether to take the vaccine or to be infected,” said Dr. Graham. “Within the next few years, it is likely most people will be immune to SARS-CoV-2, either through vaccination or infection, and vaccination is a lot safer than infection—even more so if you have risk factors for severe disease, like diabetes.” 

While there were no significant adverse events reported in the clinical trials for the vaccines, a small number of study participants had serious allergic reactions—mostly people who already had a history of allergies or anaphylaxis. However, there have been no serious adverse effects reported that are associated with diabetes. 

Side effects of the vaccine are generally mild and include injection site soreness, headaches, fever, chills, and nausea. Therefore, health care professionals should advise patients who have diabetes to monitor their blood glucose levels after being vaccinated. 

Patients might express concern that the vaccine will cause them to develop COVID-19, but this is false. Health care professionals should reassure patients that they cannot get sick from COVID-19 just by receiving the vaccine.

Two of the three COVID-19 vaccines use a novel approach to build antibodies that involve messenger ribonucleic acid, or mRNA. These are the first mRNA vaccines produced and tested in large phase III clinical trials. People have had questions about what exactly the vaccine is and how it works. Some people fear the vaccine can alter a person’s DNA, but this is not the case. The mRNA component of the Moderna and Pfizer/BioNTech vaccines contains genetic instructions needed for ribosomes within cells to manufacture spike proteins. These spike proteins match the spike proteins found on the surface of the SARS-CoV-2 virus and produce antibodies.

The Johnson & Johnson vaccine uses a more traditional method—specifically, a disabled adenovirus—to instruct ribosomes in cells to make spike proteins. The adenovirus used in the Johnson & Johnson vaccine is completely unrelated to the SARS-CoV-2 virus and cannot cause COVID-19.

The bottom line is, both types of vaccines are very safe and highly effective in helping people develop antibodies against serious COVID-19 infection.

“Giving your patients a strong recommendation for vaccination and being able to answer their questions or refer them to places where questions can be answered would make a big difference in the outcome for patients, their families, and the pandemic in general,” added Dr. Graham.

For more information about how health care professionals can talk with patients about COVID-19 vaccine, see these resources from the CDC.