Understanding the risk and impact of shingles and RSV on your patients with diabetes

Actor portrayal.

Diabetes has been associated with an increased risk of shingles.1 Complicated diabetes can increase the risk of severe RSV.2

In 2025, it is estimated that 22.7 million individuals aged ≥50 years have diabetes.3*

  • *

    Estimated number of adults aged ≥50 years with select comorbidities are based on prevalence estimates obtained from a retrospective, cross-sectional analysis of pooled 2011-2020 data from the National Health and Nutrition Examination Survey (NHANES) on self-reports of diagnoses by an HCP. The study included 26,280 adults aged ≥20 years, with population weights provided by NHANES used to subsequently extrapolate findings to the entire 2020 US non-institutionalized adult population. Prevalence estimates of comorbidities were then extrapolated to 2025 population estimates obtained from the US Census Bureau.3

HCP=healthcare professional; RSV=respiratory syncytial virus.

Diabetes and the risk of shingles

Patients aged ≥50 years are at increased risk of shingles.4 Diabetes has been associated with an increased risk of shingles and increased odds of developing postherpetic neuralgia (PHN).1,5

The risk of shingles sharply increases starting at age 50 and continues to increase with age.4 In addition to age, diabetes has been identified as an additional risk factor.1

PATIENTS WITH DIABETES HAD A

24

%

INCREASED RISK OF SHINGLES COMPARED WITH PATIENTS WITHOUT DIABETES1†

  • 32 studies, pooled effect estimate: RR: 1.24 (95% CI, 1.14, 1.35)1

†Data from a meta-analysis assessing risk factors for HZ. The analysis included a total study population of 198,751,846 individuals, with 3,768,691 HZ cases across 88 studies (68 cohort and 20 case-control studies) from 1966 to 2019. The populations in these studies ranged from people aged 3 months to 104 years. Eighteen risk factors were identified in the meta-analysis. Limitations included the following: most studies were observational and had a higher likelihood of bias; the majority of studies used administrative data, which is subject to miscoding, errors, and variation between practitioners; finally, heterogeneity was high across studies.1

PATIENTS WITH DIABETES HAD

19

%

INCREASED ODDS OF DEVELOPING PHN AFTER SHINGLES, COMPARED WITH THOSE WITHOUT DIABETES5‡

  • aOR: 1.19 (99% CI, 1.07, 1.33)5
  • Among 8492 patients with diabetes and shingles, 789 (9.3%) developed PHN5

‡UK observational study using Clinical Practice Research Datalink. Among 119,413 patients with shingles (median age 61 years) diagnosed between January 2000 and December 2011, 5.8% developed PHN (defined as pain persisting for ≥90 days following shingles diagnosis). Odds ratios for PHN were modeled for select comorbidities and adjusted for age, sex, socioeconomic status, HIV, leukemia, lymphoma, myeloma, hematopoietic stem cell transplantation, other unspecified cellular immune deficiencies, rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, COPD, asthma, CKD, depression, personality disorder, diabetes, recent cancer diagnosis, smoking, BMI category, site of zoster, antivirals, and immunosuppressive therapies.5

IN AN OBSERVATIONAL STUDY, WITHIN THE FIRST MONTH FOLLOWING A SHINGLES DIAGNOSIS

4.9

%

OF PATIENTS WITH TYPE 2 DIABETES (T2D) HAD A HOSPITAL ADMISSION6§

  • Compared with 2.1% of patients with T2D without a shingles diagnosis during a 1-month period6
  • In the same study, within the first month following a shingles diagnosis, 4% of patients with no T2D had a hospital admission6

§Data from an observational retrospective cohort analysis using US commercial claims data from 2012 to 2018 for adults 18 years and older with T2D assessing HZ incidence, all-cause healthcare resource utilization, and direct medical cost. The study included 26,070 patients with T2D with an HZ diagnosis, another 26,070 patients with T2D without an HZ diagnosis, and 26,071 patients with HZ without a T2D diagnosis (mean age at index across the 3 cohorts: 61.8-62.2 years).6

  • aOR=adjusted odds ratio; BMI=body mass index; CI=confidence interval; CKD=chronic kidney disease; COPD=chronic obstructive pulmonary disease; HIV=human immunodeficiency virus; HZ=herpes zoster; RR=risk ratio; T2D=type 2 diabetes.

Diabetes and the risk of RSV

Diabetes is considered a major risk factor for severe RSV.7

ADULTS WITH DIABETES WERE

2.4x-6.4x

MORE LIKELY TO BE HOSPITALIZED WITH RSV7¶

  • Based on IRRs observed in adults aged 50-64 years and ≥65 years with and without diabetes.7

A prospective surveillance study was conducted in the United States to estimate the incidence of RSV-associated hospitalization among adults aged ≥18 years with and without certain comorbidities (N=1099) over 3 seasons (2017-2018, 2018-2019, and 2019-2020).7

   

~39

%

OF PEOPLE AGED ≥60 YEARS HOSPITALIZED WITH RSV HAD DIABETES8#

#An observational, retrospective cohort study was conducted in a health system in Southern California to assess demographics, hospital utilization, and outcomes of patients aged ≥60 years hospitalized with RSV (N=645) from 2011-2015.8

IRR=incidence rate ratio.

Are you familiar with shingles and RSV preventive care options for your patients with diabetes?

EXPLORE SHINGLES PREVENTION
EXPLORE RSV PREVENTION

References

  1. Marra F, Parhar K, Huang B, Vadlamudi N. Risk factors for herpes zoster infection: a meta-analysis. Open Forum Infect Dis. 2020;7(1):1-8.

  2. Respiratory syncytial virus infection (RSV). RSV vaccine guidance for adults. Centers for Disease Control and Prevention. Reviewed July 8, 2025. Accessed July 10, 2025. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html

  3. Data on file, GSK.

  4. Shingles (herpes zoster). Clinical overview of shingles (herpes zoster). Centers for Disease Control and Prevention. Reviewed June 27, 2024. Accessed August 15, 2025. https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

  5. Forbes HJ, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: a cohort study. Neurology. 2016;87(1):94-102.

  6. Poirrier JE, Meyers JL, Nagar SP, Patterson BJ, Glasser LI, Jabbour SA. Herpes zoster incidence and burden in adults with type 2 diabetes in the U.S.: a retrospective database analysis. Diabetes Care. 2022;45(11):2585-2593.

  7. Branche AR, Saiman L, Walsh EE, et al. Incidence of respiratory syncytial virus infection among hospitalized adults, 2017–2020. Clin Infect Dis. 2022;74(6):1004-1011.

  8. Ackerson B, Tseng HF, Sy LS, et al. Severe morbidity and mortality associated with respiratory syncytial virus versus influenza infection in hospitalized older adults. Clin Infect Dis. 2019;69(2):197-203.