# Association between Glycosylated Hemoglobin Levels and Vaccine Preventable Diseases: A Systematic Review

## TL;DR

This review finds that both high and low HbA1c levels are linked to higher risks of herpes zoster and severe outcomes in men with diabetes and COVID-19.

## Contribution

The first systematic review to synthesize evidence on the association between HbA1c levels and vaccine-preventable diseases.

## Key findings

- Higher HbA1c levels (>10.3%) are associated with a 44% increased risk of herpes zoster.
- Both low (HbA1c <5.0%) and high (HbA1c >9.5%) levels are linked to higher herpes zoster risk.
- HbA1c >7.5% is associated with increased mortality in men with diabetes and COVID-19.

## Abstract

People with diabetes are at higher risk of serious complications from many vaccine-preventable diseases (VPDs). Some studies have highlighted the potential impact of glycosylated hemoglobin levels (HbA1c), but no systematic review has synthesized these findings. Of the 823 identified studies, 3 were included, for a total of 705,349 participants. Regarding the incidence of herpes zoster (HZ), one study found that higher HbA1c levels at the baseline (>10.3%) were associated with a significantly higher risk of HZ of 44%, compared to those with a good HbA1c control (6.7%). On the contrary, the second one reported that when compared to the reference group (HbA1c of 5.0–6.4%), participants with a HbA1c less than 5.0% were at higher risk of HZ of 63%, whilst participants with a HBA1c more than 9.5% had a similar risk. Finally, the third study observed that diabetes, defined using a value of HbA1c more than 7.5%, was associated with an increased risk of mortality in men with COVID-19. In conclusion, both high and low HBA1c levels appear to be associated with a higher risk of HZ. Regarding COVID-19, a value of HbA1c more than 7.5% was associated with a higher risk of death in COVID-19, but only in men.