COVID-19 Vaccines and Hyperglycemia—Is There a Need for Postvaccination Surveillance?

Abstract

The COVID-19 vaccines currently in use have undoubtedly played the most significant role in combating the SARS-CoV-2 virus and reducing disease severity and the risk of death among those affected, especially among those with pre-existing conditions, such as diabetes. The management of blood glucose levels has become critical in the context of the COVID-19 pandemic, where data show two- to threefold higher intensive care hospital admissions and more than twice the mortality rate among diabetic COVID-19 patients when compared with their nondiabetic counterparts. Furthermore, new-onset diabetes and severe hyperglycemia-related complications, such as hyperosmolar hyperglycemic syndrome (HHS) and diabetic ketoacidosis (DKA), were reported in COVID-19 patients. However, irrespective of the kind of vaccine and dosage number, possible vaccination-induced hyperglycemia and associated complications were reported among vaccinated individuals. The current article summarizes the available case reports on COVID-19 vaccination-induced hyperglycemia, the possible molecular mechanism responsible for this phenomenon, and the outstanding questions that need to be addressed and discusses the need to identify at-risk individuals and promote postvaccination monitoring/surveillance among at-risk individuals.

European Safety Analysis of mRNA and Viral Vector COVID-19 Vaccines on Glucose Metabolism Events

“…This analysis for COVID-19 vaccines showed a total of 1464 ICSRs related to hyperglycemia, 1137 to diabetes mellitus, 25 to hyperosmolar hyperglycemic syndrome, and 398 to diabetic ketoacidosis. However, it remains unclear whether the low frequency is due to rarity, a lack of proper vaccine surveillance, and/or under-reporting [13]. Indeed, under-reporting is a primary concern in pharmacovigilance that needs continuous surveillance and proactive stimulation.…”

“…Since their approval, data on the safety profile have been published, but few have been related to the occurrence of impaired glucose metabolism events. Case series showed a link between such events and COVID-19 vaccination in both patients with and without diabetes mellitus [8][9][10][11][12][13]. Based on this gap in knowledge, we decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV) and to assess the reporting frequency of COVID-19 vaccines.…”

BNT162b2 mRNA COVID-19 Vaccine Does Not Impact the Honeymoon Phase in Type 1 Diabetes: A Case Report

“…The possible mechanisms by which COVID-19 vaccines may cause hyperglycemia remain to be determined. Samuel et al [ 7 ] hypothesized that ViHG may be caused by pancreatic injury and/or acute pancreatitis secondary to reduced pancreatic blood flow and increased cellular oxidative stress. According to this hypothesis, case reports of pancreatic injury/acute pancreatitis following the administration of the Pfizer-BioNTech COVID-19 mRNA vaccine have been described [ 40 , 41 , 42 ].…”

“…The transient alteration in blood glucose levels may be more pronounced in individuals with existing impaired glucose control. Of note, the rise in circulating levels of pro-inflammatory cytokines (e.g., TNF-α, IL-1, IL-6, IFN-γ) in response to different triggers (e.g., vaccine excipients, adenoviral vectors, or the vaccine-derived SARS-CoV-2 spike protein immunogen) may cause pancreatic beta-cell dysfunction/injury [ 43 , 44 ] and/or insulin resistance [ 45 , 46 , 47 ], resulting in an acute impairment of blood glucose levels [ 7 , 48 , 49 ].…”

“…The currently available COVID-19 vaccines have undoubtedly played a major role in reducing COVID-19 incidence, morbidity, and mortality [ 6 ]. However, there have been several reports of vaccination-induced hyperglycemia (ViHG) and associated complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in both nondiabetic and diabetic subjects, irrespective of the vaccine type and dose number [ 7 , 8 ]. These patients usually presented with typical symptoms of hyperglycemia (polyuria, nocturia, and polydipsia), with some subjects reporting significant weight loss, disorientation, and lightheadedness [ 7 ].…”