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Humoral immune response of COVID-19 vaccination in diabetic patients




The prevalence of diabetes in individuals hospitalized for coronavirus infection (COVID-19) in 2019 reaches as high as 20%, and many patients who experience a serious course of COVID-19 are diabetic. In-hospital mortality for diabetic (DM) COVID-19 patients can reach as high as 25%.

study: Humoral immune response to Covid-19 vaccination in diabetes: age-dependent but independent of diabetes type and glycemic control – prospective COVAC-DM cohort study.. Image Credit: Gecko Studio / Shutterstock

Chronic, systemic, mild inflammation is characteristic of metabolic disorders such as type 2 diabetes (T2D). It causes exaggerated cytokine release, inflammation, impaired phagocytosis, or glycation of immunoglobulins. This changes the outcome of diabetics exposed to infection. In addition, patients with type 2 diabetes have existing changes in the adaptive immune system (B and T lymphocytes). T cells It expresses low levels of co-stimulatory molecules or interleukin (IL) -12 receptors. In addition, elimination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires an effective response of the adaptive immune system.

Therefore, diabetics are considered a high-risk population to experience the adverse consequences of COVID-19. COVID-19 vaccination is highly recommended in this population. This prioritizes current immunization strategies in most countries. However, it remains doubtful whether diabetics will face a diminished immune response after SARS-CoV2 vaccination.

the study

New research published in medRxiv* Preprint server is humoral associated with COVID-19 vaccine in individuals with type 1 diabetes (T1D) and T2D to elucidate the effects of diabetes type and glycemic control on antibody response after COVID-19 vaccination. We investigated the immune response and side effects.

This study aims to compare SARS-CoV-2 antibody levels after COVID-19 vaccination in diabetic patients with healthy non-diabetic controls.

The “Immune Response to Covid-19 Vaccination in Diabetes Patients-COVAC-DM” study was a prospective, multicenter cohort study of 161 DM patients at two centers in Austria – the Medical University of Graz and the University of Medicine. .. University of Insbrook, and one center in Germany-University of Bayreuth.

T1D or T2D participants aged 18-80 years who were diagnosed with diabetes before receiving the COVID-19 vaccine were recruited from the outpatient clinics at participating sites. Participants were then enrolled in one of four predefined groups, depending on glycated hemoglobin (HbA1c) and type of diabetes. Insufficient management of T1D with HbA1c exceeding 7.5%. Well-controlled T2D with HbA1c ≤ 7.5%; and T2D with HbA1c above 7.5% was poorly controlled.

Overall, 161 patients were enrolled between April and June 2021, of which 150 were included in the final analysis.

Investigation result

Seventy-five participants suffered from T1D, 49 of whom belonged to a well-managed group (mean HbA1c was 6.6 ± 0.6%, 26 were poorly managed), with a mean HbA1c of 8.4 ± 0.9%. bottom. On the other hand, 75 participants suffered from T2D, 37 of whom had well-controlled diabetes (mean HbA1c was 6.5 ± 0.6%, 38 had poorly controlled diabetes), and average. HbA1c was 8.4 ± 0.9%.

The control group consisted of 86 healthy participants. Of these, 49 (57%) were females with an average age of 48 ± 11.6 years, 96.5% received the Moderna vaccine and 3.5% received the BioNTech / Pfizer vaccine.

Three hospitalizations were recorded after vaccination. One occurred 24 days after the first vaccination due to peripheral edema and chronic heart failure. 12 days after the second vaccination of atrioventricular block grade 3. The third hospitalization was caused by a miscarriage 10 weeks after pregnancy.

The results show that 52.7% of T1D patients and 48.0% of T2D patients have anti-SARS-CoV2-S antibodies above the detection limit of 0.8 and have low medians 10-14 days after the first vaccination. I did.

The findings showed that patients with T1D and T2D exhibited a humoral immune response to the COVID-19 vaccine as measured by the anti-receptor binding domain SARS-CoV-2S antibody compared to healthy controls. ..

Higher antibody levels were detected in individuals with well-controlled T1D. However, this difference does not persist after adjusting for age, gender, and multiple comparisons. The findings also showed that age and estimated glomerular filtration rate (eGFR) predict antibody levels after COVID-19 vaccination, but not HbA1c levels.

The findings were pointed out to be inconsistent with a recent observational study in Italy (CAVEAT study) that showed low antibody response to COVID-19 vaccination in patients with type 2 diabetes with HbA1c greater than 7.0%. This was accompanied by a decrease in the CD4posT cell response as measured by the tumor necrosis factor (TNF) -α, IL-2, or interferon (IFN) -γ response.

Age has been found to be a major determinant of the humoral immune response to COVID-19 vaccination. Previous data confirm that older people show lower antibody responses to these vaccines and show a more rapid decline of antibodies.

Another clinical feature that predicts antibody response is – renal function or eGFR. This data suggests that individuals with diabetes and advanced diabetic nephropathy need to have shorter re-vaccination intervals.


This study found no correlation between anti-SARS-CoV-2S antibodies and the duration of diabetes. On the other hand, the correlation between these antibodies and the patient’s obesity index was fairly weak.

It is speculated that anti-SARS-CoV-2 S antibody levels after the second dose of COVID-19 vaccine were comparable between healthy controls and individuals with T1D and T2D, regardless of glycemic control. On the other hand, age and renal function were significantly correlated with the degree of antibody levels.

*Important Notices

medRxiv publishes unpeer-reviewed preliminary scientific reports and should not be considered definitive, guide clinical / health-related behaviors, or be treated as established information.





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