Association between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis.

Context Individuals with diabetes mellitus (DM) are susceptible to various infections. Objective We estimated the risk of herpes zoster (HZ) among individuals with DM compared to individuals in the general population. Data sources We searched the PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trails, Cumulative Index to Nursing and Allied Health Literature and PerioPath databases from their inception to January 30, 2021 for studies on the risk of HZ in individuals with DM. Study selection Two authors independently screened all articles identified. Data extraction The same two authors independently extracted the data. Four case-control studies and 12 cohort studies were included. Data synthesis Meta-analyses were performed using fixed and mixed-effects models. In the pooled analysis, individuals with DM had a higher risk of developing HZ (pooled relative risk: 1.38, 95% confidence interval: 1.21-1.57) than individuals in the general population. The results were consistent in subgroup analyses stratified by type of diabetes, age, and study design. In individuals with DM, cardiovascular disease had an additive effect on increasing the risk of HZ (pooled relative risk: 1.19, 95% confidence interval: 1.11-1.28). There was a linear dose-response association between age and the risk of HZ in individuals with DM. Conclusion Individuals with DM have an increased risk of HZ compared to the general population. Varicella vaccination should be provided to individuals with DM regardless of their age, prioritizing older adults and those with cardiovascular disease. Varicella vaccination policies for individuals with DM should be updated based on the evidence.