Association of Impaired Fasting Glucose and Diabetes with SARS-CoV-2 Spike Antibody Titers after the BNT162b2 Vaccine among Health Care Workers in a Tertiary Hospital in Japan

Abstract

Background: Hyperglycemia can alter the activation of innate and acquired immunity, but epidemiological evidence linking hyperglycemia to post-vaccination immunogenicity is limited. Objective: To examine the association between SARS-CoV-2 spike antibody titers after the COVID-19 vaccine and impaired fasting glucose (IFG) and diabetes. Methods: Participants were 953 health care workers aged 21–75 years who were tested for SARS-CoV-2 spike IgG antibodies and underwent a health checkup two months after their second dose of the BNT162b2 vaccine. IFG was defined as a fasting plasma glucose (FPG) level of 100–125 mg/dL, and diabetes was defined as an FPG level ≥126 mg/dL or being under medical care for diabetes. Multivariable linear regression was used to calculate the ratio of the mean. Result: Spike IgG antibody titers were lower in the presence of hyperglycemia; the ratios of the means (95% CI) were 1.00, 0.79 (0.60–1.04), and 0.60 (0.42–0.87) for individuals with normoglycemia, IFG, and diabetes, respectively (p trend < 0.001). Restricted cubic spline regression analysis showed that IgG spike antibody titers decreased linearly with increasing concentrations of FPG. Conclusion: Diabetes and, to a lesser extent, IFG may be associated with poor humoral immune response after BNT162b2 vaccination.

SARS-CoV-2 omicron variant clearance delayed in breakthrough cases with elevated fasting blood glucose

“…Glucose-like metabolite deficiency may facilitate viral entry and replication, as described previously [ 21 ]. Another mechanism is that the production of neutralizing antibodies is reduced in diabetes [ 18 , 26 ]. In addition, our results showed that CD4 + T cell count is low in patients without early viral clearance and is negatively related to glucose.…”

“…High fasting plasma glucose level (≥ 6.1 mmol/L) at admission is an independent predictor for prolonged SARS-CoV-2 shedding [ 17 ]. Individuals with hyperglycemia had lower spike IgG titer than those with normoglycemia after two doses of the BNT162b2 vaccine, indicating that hyperglycemia is associated with a poor humoral immune response [ 18 ]. In young adults with type 1 diabetes, the elevated glucose level is positively associated with persistent symptoms [ 19 ].…”