Standards of Medical Care
24
Immunization
Î Annually provide an influenza vaccine to all diabetic patients
≥6 months of age. (C)
Î Administer pneumococcal polysaccharide vaccine to all diabetic
patients ≥2 years of age. A one-time revaccination is recommended for
individuals >65 years of age who have been immunized >5 years ago.
Other indications for repeat vaccination include nephrotic syndrome,
chronic renal disease, and other immunocompromised states, such as
after transplantation. (C)
ÎAdminister hepatitis B vaccination to unvaccinated adults with diabetes
who are aged 19-59 years. (C)
Î Consider administering hepatitis B vaccination to unvaccinated adults
with diabetes who are aged ≥60 years. (C)
Employment and Driving
Î Any person with diabetes, whether insulin treated or noninsulin
treated, should be eligible for any employment for which he/she is
otherwise qualified. (See the ADA position statement on Diabetes and
Employment – http://professional.diabetes.org/employment)
Î When questions arise about the medical fitness of a person with
diabetes for a particular job, a health care professional with expertise
in treating diabetes should perform an individualized assessment.
Î The ADA position statement on Diabetes and Driving (http://
professional.diabetes.org/driving) recommends against blanket
restrictions based on the diagnosis of diabetes and urges individual
assessment by a health care professional knowledgeable in diabetes if
restrictions on licensure are being considered.
Î Patients should be evaluated for decreased awareness of
hypoglycemia, hypoglycemia episodes while driving, or severe
hypoglycemia.
Î Patients with retinopathy or peripheral neuropathy require
assessment to determine if those complications interfere with
operation of a motor vehicle.
Î Health care professionals should be cognizant of the potential risk of
driving with diabetes and counsel their patients about detecting and
avoiding hypoglycemia while driving.
