Does having diabetes make my Herpes Zoster infection more likely to be severe?

If you have diabetes and get shingles (herpes zoster), your infection may be more severe than in someone without diabetes. Research shows that people with diabetes are not only more likely to get shingles, but they also tend to have worse outcomes, such as a higher risk of the rash spreading beyond its original area (disseminated zoster) and a greater chance of developing long-term nerve pain called postherpetic neuralgia. The good news is that there are steps you can take to reduce your risk, including vaccination and careful management of your blood sugar.

What the research says

A large meta-analysis found that people with diabetes have about a 38% higher risk of developing shingles compared to the general population ⁹. Another population-based study showed that people with diabetes use more healthcare resources for their shingles episodes, meaning their infections tend to be more severe or complicated ¹⁰. Specifically, a study of hospitalized shingles patients found that those with disseminated shingles (rash spread over a wide area) had a significantly higher rate of newly diagnosed diabetes (22.2%) compared to those with localized shingles (11.9%) ⁶. This suggests that severe shingles can be a sign of undiagnosed or poorly controlled diabetes. Additionally, a study on postherpetic neuralgia identified diabetes as one of the key risk factors for developing this painful complication after shingles ³. While diabetes itself is a form of immunocompromise that can worsen shingles, other conditions that weaken the immune system, such as rheumatoid arthritis or use of high-dose corticosteroids, also increase the risk of severe disease ¹²⁷. The Advisory Committee on Immunization Practices (ACIP) recommends the recombinant zoster vaccine for immunocompromised adults aged 19 and older, which includes many people with diabetes ⁵.

What to ask your doctor

• Should I get the shingles vaccine (Shingrix) to reduce my risk of severe infection?
• How can I better manage my blood sugar to lower my risk of shingles complications?
• If I get shingles, what are the early signs that I should watch for that might indicate a severe case?
• Am I at higher risk for postherpetic neuralgia because of my diabetes, and what can be done to prevent it?
• Do I need to be screened for diabetes if I have had a severe or widespread shingles infection?