Type 1 diabetes mellitus following COVID‐19 RNA‐based vaccine

Abstract

The epidemic of coronavirus disease‐2019 (COVID‐19) is the major public health issue in the world. COVID‐19 vaccines are one of the most effective strategies against COVID‐19. Here we report a 36‐year‐old female patient who had thirst, polydipsia, polyuria, palpitations, loss of appetite, and fatigue 3 days after the first dose of COVID‐19 RNA‐based vaccines without a prior history of diabetes. Ten days after vaccination, she visited our hospital with diabetic ketoacidosis and was diagnosed with type 1 diabetes. Hyperglycemia (501 mg/dL), anion gap metabolic acidosis and ketonuria were observed. The glycated hemoglobin level was 7.0%. Islet‐related autoantibodies were all negative. The glucagon tolerance test revealed attenuated secretion of insulin. Human leukocyte antigen was haplotype DRB1*0405‐DQB1*0401, which was associated with type 1 diabetes in Japan. The present case suggests that COVID‐19 RNA‐based vaccines might trigger the onset of type 1 diabetes, even in subjects without prior histories of diabetes.

New‐onset atypical fulminant type 1 diabetes after COVID‐19 vaccination: A case report

“… 4,5 By contrast, the time for progression of symptoms from onset after vaccination was relatively short (approximately 1 week) in fulminant type 1 diabetes (Table 4). 9–11 Moreover, anti‐GAD antibodies in patients in previous reports were negative in all cases. In the present study, the patient's anti‐GAD antibodies were moderately positive.…”

Endocrine system after 2 years of COVID-19 vaccines: A narrative review of the literature

“…Anti-glutamic acid decarboxylase antibodies and/or insulin autoantibodies were found in nine patients ( 62 , 64 , 67 , 70 , 71 ). Five patients ( 64 – 68 ) were found to have HLA haplotypes known to confer T1DM risk.…”

“…The possible link between vaccinations and the occurrence of T1DM has been investigated for many different vaccines to date, such as vaccines against influenza virus A/H1N1 ( 131 ), Rotavirus ( 132 ), human papilloma virus (HPV) ( 133 ), with the general agreement that vaccinations are not associated with increased risk of islet autoimmunity or T1DM ( 134 , 135 ). To date, only few cases of post-COVID-19 vaccination acute diabetes onset have been reported, and in almost all patients a pre-existing genetic predisposition was confirmed ( 64 – 68 ). Therefore, these findings are too few to draw any conclusions about the possible pathogenetic mechanism.…”

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

“…It has been hypothesized that these disorders occur as a result of different mechanisms, including autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA), mRNA “self-adjuvant” properties, immune disruption from external stimuli, and molecular mimicry between viral antigen proteins and human proteins (e.g., beta-cell antigens) [ 58 ]. In this regard, there have been case reports of adult-onset autoantibody-negative fulminant T1D [ 60 , 61 ] and autoantibody-positive T1D [ 62 , 63 ] that occurred after the administration of different COVID-19 vaccine types and were characterized by severe insulinopenia and/or DKA development. Sasaki et al [ 64 ] hypothesized that two different pathophysiological mechanisms may underlie these two distinct forms of T1D observed after COVID-19 vaccination.…”