New-onset Type 1 Diabetes after COVID-19 mRNA Vaccination

Abstract

During the ongoing coronavirus disease 2019 (Covid-19) pandemic, it is critical to ensure the safety of Covid-19 vaccines. We herein report a 51-year-old Japanese woman who developed acute-onset type 1 diabetes with diabetic ketoacidosis six weeks after receiving the first dose of a Covid-19 mRNA vaccine. Laboratory tests indicated exhaustion of endogenous insulin secretion, a positive result for insulin autoantibody, and latent thyroid autoimmunity. Human leukocyte antigen typing was homozygous for DRB1*09:01-DQB1*03: 03 haplotypes. This case suggests that Covid-19 vaccination can induce type 1 diabetes in some individuals with a genetic predisposition.

Could the development of COVID-19 vaccine-induced type 1 diabetes be explained by a simple mechanism?

“…In these cases, both patients were administered mRNA vaccines, and the patients’ islet autoantibodies were positive, which was different from the type of vaccine and characteristics of T1DM reported in this journal. However, very interestingly, in agreement with this journal's report, both patients had one of the disease-susceptible HLA haplotypes, i.e., DRB1*04:05-DQB1*04:01 [2] and DRB1*09:01-DQB1*03:03 [3] , so we totally agree with the authors’ opinion that vaccination of genetically susceptible recipients should be cautious concerning future development of T1DM. Although the authors made little mention about the mechanisms of the development of vaccine-induced T1DM, we would focus on the difference in the time from vaccination to the appearance of hyperglycemic symptoms between this case and the previous reports of Covid-19 vaccine-induced acute-onset T1DM.…”

“…Although the authors made little mention about the mechanisms of the development of vaccine-induced T1DM, we would focus on the difference in the time from vaccination to the appearance of hyperglycemic symptoms between this case and the previous reports of Covid-19 vaccine-induced acute-onset T1DM. That is, in the present report [1] , hyperglycemic symptoms occurred within just one week after the first vaccination, whereas these symptoms in new-onset of T1DM with positive for autoantibodies occurred four to seven weeks after the first or second vaccination [2] , [3] , [4] , indicating a clear difference. Although we cannot exclude the possibility that this discrepancy was attributable to the different types of vaccines, i.e., inactivated vaccine [1] versus mRNA vaccine [2] , [3] , [4] , such a wide variation in the duration of disease onset suggests that there might be no single mechanism of beta-cell destructions and the development of hyperglycemia associated with Covid-19 vaccination [2] .…”

“…That is, in the present report [1] , hyperglycemic symptoms occurred within just one week after the first vaccination, whereas these symptoms in new-onset of T1DM with positive for autoantibodies occurred four to seven weeks after the first or second vaccination [2] , [3] , [4] , indicating a clear difference. Although we cannot exclude the possibility that this discrepancy was attributable to the different types of vaccines, i.e., inactivated vaccine [1] versus mRNA vaccine [2] , [3] , [4] , such a wide variation in the duration of disease onset suggests that there might be no single mechanism of beta-cell destructions and the development of hyperglycemia associated with Covid-19 vaccination [2] . In the former case, negative autoantibodies and the earlier onset suggested that direct damage to beta cells by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins or proinflammatory cytokines induced by Covid-19 vaccination might be the primary etiology.…”

“…The work and efforts of the authors in reporting this valuable case are highly appreciated. Almost simultaneously, cases of acute-onset T1DM in Japanese women induced by Covid-19 vaccination were reported [ 2 , 3 ], including the case we presented. In these cases, both patients were administered mRNA vaccines, and the patients’ islet autoantibodies were positive, which was different from the type of vaccine and characteristics of T1DM reported in this journal.…”

New‐onset fulminant type 1 diabetes after severe acute respiratory syndrome coronavirus 2 vaccination: A case report

“…Under the current pandemic of coronavirus disease 2019 (COVID‐19), over 4 billion people worldwide have received at least one dose of vaccine against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) 2 . Recently, cases of several kinds of immune‐mediated disorders 3 , 4 , 5 , including type 1 diabetes 4 , 6 , have been documented after SARS‐CoV‐2 vaccination. Although a causal relationship remains undetermined, these cases suggest an involvement of SARS‐CoV‐2 vaccination in the onset of autoimmune type 1 diabetes.…”