Herpes zoster hospitalization as a sentinel signal for undiagnosed dysglycemia: a call for routine glycemic screening in clinical practice

Background Although diabetes mellitus (DM) is an established risk factor for herpes zoster (HZ), the prevalence of undiagnosed dysglycemia in hospitalized HZ patients, and its association with HZ severity, are not well characterized. This study investigated the prevalence of newly identified diabetes and prediabetes in a cohort of patients hospitalized for HZ, comparing those with disseminated and localized presentations. Methods A retrospective cohort analysis of 564 hospitalized patients with HZ from 2020 to 2024 after exclusion was performed. The patients were divided into localized and disseminated HZ groups based on their clinical presentation. Diabetes was diagnosed on the basis of the 2023 American Diabetes Association (ADA) criteria. Multivariable logistic regression was used to identify independent risk factors for diabetes. Results Among 564 hospitalized HZ patients, 45 were diagnosed with disseminated HZ. Disseminated HZ was associated with a significantly higher prevalence of newly identified diabetes (22.2% [10/45] vs. 11.9% [62/519], P = 0.048) and prediabetes (33.3% [15/45] vs. 13.1% [68/519], P<0.001), as well as poorer chronic glycemic control (median HbA1c 8.90% vs. 7.50%, P = 0.021).Multivariable logistic regression model confirmed disseminated HZ as an independent predictor of diabetes (adjusted OR = 2.06, 95% CI 1.15–3.69), alongside age >60 years and BMI >25 kg/m². Elevated LDL-C and triglycerides were also significant independent risk factors. Conclusion Our study identifies disseminated HZ as a key sentinel for previously unrecognized dysglycemia. Routine glycemic screening should be integrated into admission protocols for all hospitalized HZ patients, particularly for severe cases.