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Immunity to hepatitis B virus (HBV) induced through vaccination may offer protection against diabetes.

In a study, researchers found that individuals with no prior HBV infection but with measurable hepatitis B surface antibodies (HBsAb), a marker of immunity usually acquired through vaccination, had a significantly lower risk for diabetes than those without immunity.

“This finding suggests that HBV immunity may be associated with a lower risk of diabetes through mechanisms beyond the prevention of HBV infection, potentially involving unique metabolic pathways,” they wrote.

The study was published online in Diagnostics and will be presented next week at the European Association for the Study of Diabetes (EASD) 2025 Annual Meeting in Vienna, Austria.

Dual Benefits?

In 2024, nearly 589 million people worldwide were living with diabetes, a number projected to reach more than 850 million by 2050.

Previous studies have shown that HBV infection can disturb liver metabolism and increase diabetes risk, and that HBV vaccination could reduce this risk. However, the independent effect of HBV-induced immunity on diabetes prevention has been unclear.

To investigate, a team led by Nhu Quynh Phan, PhD, with Taipei Medical University in Taipei, Taiwan, conducted a large retrospective cohort study using electronic health records from the TriNetX Global Collaborative Network.

They included adults with HBsAb blood serology between 2005 and 2023 and no prior history of HBV infection or diabetes. A total of 291,231 immunized individuals (HBsAb ≥ 10 mIU/mL) were propensity score matched with an equal number of unimmunized individuals (HBsAb < 10 mIU/mL).

During follow-up lasting up to 15 years, the HBV-immunized group had a 15% lower risk of developing diabetes (hazard ratio [HR], 0.85).

A dose-response effect was observed, with higher antibody levels offering greater protection; risk was reduced by 19% (HR, 0.81) in those with HBsAb ≥ 100 mIU/mL and by 43% (HR, 0.57) in those with HBsAb ≥ 1000 mIU/mL.

The protective association with HBV immunity was consistent across sexes but appeared stronger in younger people than in middle-aged and older adults.

Immunized adults aged 18-44 years had a 20% (HR, 0.80) lower risk for diabetes than unimmunized peers, while the risk reductions were 11% (HR, 0.89) in those aged 45-64 years and 12% (HR, 0.88) in those aged 65 years or older.

Younger individuals may experience greater protection than older individuals due to immunosenescence, the natural aging of the immune system, which can diminish vaccine-induced immune responses in older adults, the authors said.

Geographical differences also emerged, with the most pronounced effect observed in Europe, the Middle East, and Africa, and the weakest in the US.

Overall, the findings suggest that expanding hepatitis B vaccination programs could provide dual benefits — protecting against both HBV and diabetes — particularly in regions where both diseases are highly prevalent, the authors said.

They cautioned, however, that more research is needed to confirm causality, understand the biologic mechanisms involved, and account for possible confounding factors such as lifestyle and health behaviors.

The study reported receiving no external funding. The authors declared having no conflicts of interest.