Third dose of COVID‐19 vaccine in diabetes: Relevance of good metabolic control to improve its efficacy

Pieralice, Silvia; D’Onofrio, Luca; Pozzilli, Paolo; Buzzetti, Raffaella

doi:10.1002/dmrr.3533

Cited by 6 publications

(11 citation statements)

References 23 publications

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“…Previous studies suggested that cellular and humoural responses to vaccination could be influenced by glycaemic control 10 . In particular, in a study conducted on healthy workers in Japan, diabetes was associated with a reduced level of anti‐spike Ab, and HbA1c > 6.5% further impaired the immune response 19 .…”

Section: Discussionmentioning

confidence: 99%

“…18 Previous studies suggested that cellular and humoural responses to vaccination could be influenced by glycaemic control. 10 In particular, in a study conducted on healthy workers in Japan, diabetes was associated with a reduced level of anti-spike Ab, and HbA1c > 6.5% further impaired the immune response. 19 Additionally, in the CAVEAT study, subjects with type 2 diabetes with an HbA1c >7% showed a reduced response to the vaccine 21 days after the second vaccination.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 Nevertheless, impaired response to vaccination in subjects with diabetes has been reported 9 and poor glycaemic control seems to be a detrimental risk factor in this regard. 10 …”

Section: Introductionmentioning

confidence: 99%

“…The development and administration of large‐scale SARS‐CoV2 vaccines have been a turning point in the management of Covid‐19 7,8 . Nevertheless, impaired response to vaccination in subjects with diabetes has been reported 9 and poor glycaemic control seems to be a detrimental risk factor in this regard 10 …”

Section: Introductionmentioning

confidence: 99%

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Reduced early response to SARS‐CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow‐up study: The CoVaDiab study I

D’Onofrio

Fogolari

Amendolara

et al. 2022

Diabetes Metabolism Res

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Introduction Diabetes mellitus worsens the prognosis of SARS‐CoV‐2 infection, and vaccination has been the major tool for reducing the risk of hospitalisation, and mortality. The primary aim of this study was to evaluate the response to the SARS‐CoV‐2 vaccine in subjects with diabetes and controls. Differences between type 1 (T1D) and type 2 (T2D) diabetes and clinical determinants of vaccination response were also evaluated. Methods 128 subjects with diabetes (60 with T1D and 62 with T2D) and 202 subjects acting as controls who completed a full vaccination cycle with two doses of mRNA vaccine were enroled. People with previous SARS‐CoV‐2 infection were excluded. Antibodies (Ab) directed against the spike protein of the SARS‐CoV‐2 were evaluated at one and 6 months after vaccination. Results In the whole cohort, the Ab level was higher among women than in men ( p = 0.011) and negatively correlated with age (rho = −0.155, p = 0.005). Subjects with diabetes showed decreased levels of Ab after one month compared to controls (1217[747–1887]BAU/mL vs. 1477[942–2556]BAU/mL, p = 0.002), even after correction for age and gender ( p = 0.002). No difference was found between subjects with T1D and T2D. After 6 months, antibody levels significantly decreased in people with and without diabetes, with no differences between groups, although some subjects were lost at follow‐up. In subjects with diabetes, only a significant correlation was found between Ab level and renal function (rho 0.190, p = 0.042). Conclusions Both T1D and T2D are associated with a reduced early response to vaccination. The serum concentration of Ab significantly reduced over time in both groups, highlighting the relevance of vaccination boosters independently of the presence of diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 Nevertheless, impaired response to vaccination in subjects with diabetes has been reported 9 and poor glycaemic control seems to be a detrimental risk factor in this regard. 10 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reduced early response to SARS‐CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow‐up study: The CoVaDiab study I

D’Onofrio

Fogolari

Amendolara

et al. 2022

Diabetes Metabolism Res

Self Cite

View full text Add to dashboard Cite

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“…Most of the studies reported diabetics had low antibody response to COVID-19 vaccine; a few found the reverse [30]. Though variables such as age, type of diabetes, BMI, glycemic control, eGFR, type of vaccine, numbers of administered doses, and re-vaccination intervals were affecting the antibody response, the immunogenicity of the vaccines was low in patients with diabetes mellitus compared to healthy controls [36][37][38]. Nonsmokers had higher median anti-Spike antibody level, 4059 U/mL than smokers 3149 U/mL in this study.…”

Section: Volume 5-issuementioning

confidence: 99%

Untitled

2022

JCCM

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Background: Patients with end stage renal disease (ESRD) on maintenance hemodialysis (ESRD on MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection. An altered immunologic response to COVID-19 vaccines was reported in this population. This study aimed to assess the level of anti-Spike antibody 2 weeks after 4 doses of COVID-19 vaccine in patients on MHD. Methods:A cross-sectional descriptive study was conducted in August 2022 among patients with ESRD on MHD who received COVID-19 vaccine 4 doses; last dose was 2 weeks ago. Data were collected by using standardized forms and analysis was done.Results: A total of 61 patients with ESRD on maintenance hemodialysis (ESRD on MHD) were included; all patients had raised anti-Spike antibody level; the median anti-Spike antibody level was 3912 U/mL. The mean age was 51.15 ± 12.85 years. The older age group (over 50 years) had higher anti-Spike antibody level than younger age group (less than 50 years), 4175.5 U/mL and 3024.5 U/ mL respectively. Mean BMI (dry weight) was 19.93 ± 2.83 kg/m2. Anti-Spike antibody level was highest in normal BMI group 4117 U/mL; 3180 U/mL in overweight group; and, the lowest 1680 U/mL in underweight group. This study included male 26 (42.6%) and female 35 (57.4%); no difference in anti-Spike antibody level between male (3928 U/mL) and female (3912 U/mL). Nearly 70% of them had history of COVID-19 infection and they had higher anti-Spike antibody level (4400 U/mL) than those without infection (2355 U/mL). Those with diabetes mellitus had significantly higher anti-Spike antibody level (11,935 U/mL) than those without diabetes mellitus (3,155 U/mL). Anti-Spike antibody level in smokers (3149 U/mL) was lower than that of non-smoker (4059 U/ mL). Those who got vaccinated in the morning had higher antibody level (4232 U/mL) than who got in the afternoon (3003 U/mL). Antibody response decreased with falling hemoglobin; mild anemia (4232 U/mL); moderate anemia (3103.5 U/mL); and severe anemia (1680 U/mL). Presence of diabetes mellitus was the only significant predictor for anti-Spike antibody level on univariable analysis.

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Diabetes, COVID‐19, and questions unsolved

D'Souza

Buzzetti

Pozzilli

2023

Diabetes Metabolism Res

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Recent evidence suggests a role for Diabetes Mellitus in adverse outcomes from COVID‐19 infection; yet the underlying mechanisms are not clear. Moreover, attention has turned to prophylactic vaccination to protect the population from COVID‐19‐related illness and mortality. We performed a comprehensive peer‐reviewed literature search on an array of key terms concerning diabetes and COVID‐19 seeking to address the following questions: 1. What role does diabetes play as an accelerator for adverse outcomes in COVID‐19?; 2. What mechanisms underlie the differences in outcomes seen in people with diabetes?; 3. Are vaccines against COVID‐19 efficacious in people with diabetes? The current literature demonstrates that diabetes is associated with an increased risk of adverse outcomes from COVID‐19 infection, and post‐COVID sequelae. Potential mechanisms include dysregulation of Angiotensin Converting Enzyme 2, Furin, CD147, and impaired immune cell responses. Hyperglycaemia is a key exacerbator of these mechanisms. Limited studies are available on COVID‐19 vaccination in people with diabetes; however, the current literature suggests that vaccination is protective against adverse outcomes for this population. In summary, people with diabetes are a high‐risk group that should be prioritised in vaccination efforts. Glycaemic optimisation is paramount to protecting this group from COVID‐19‐associated risk. Unsolved questions remain as to the molecular mechanisms underlying the adverse outcomes seen in people with diabetes; the functional impact of post‐COVID symptoms on people with diabetes, their persistence, and management; how long‐term vaccine efficacy is affected by diabetes, and the antibody levels that confer protection from adverse outcomes in COVID‐19.

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Third dose of COVID‐19 vaccine in diabetes: Relevance of good metabolic control to improve its efficacy

Cited by 6 publications

References 23 publications

Reduced early response to SARS‐CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow‐up study: The CoVaDiab study I

Reduced early response to SARS‐CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow‐up study: The CoVaDiab study I

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Diabetes, COVID‐19, and questions unsolved

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