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COVID-19 antibody response does not diminish in diabetes


Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center.

Neither diabetes itself nor hyperglycemia appears to impair the antibody response to SARS-CoV-2, suggesting that the COVID-19 vaccine is as effective as people without diabetes, a new study suggests. discovered.

The results of a study of 480 patients with confirmed COVID-19 seen in an Italian hospital between February 25 and April 19 are as follows: Published online October 8th Diabetology By Vito Lampasona, MD, and colleagues.

The antibody response to multiple SARS-CoV-2 antigens in 27% of patients with COVID-19 and diabetes (existing and newly diagnosed) was without COVID-19 and diabetes in terms of timing, titer, and class. Results did not depend on glucose levels.

In addition, immunoglobulin G (IgG) positivity for the SARS-CoV-2 spike receptor binding domain (RBD) was associated with improved survival regardless of diabetic status.

And Shown earlierHyperglycemia was strongly associated with increased mortality of COVID-19, even in people without diabetes.

The authors state that this is the first study of an immunological humoral response to SARS-CoV-2 in patients with hyperglycemia.

“Immune responses to future SARS-CoV-2 vaccines will be assessed when the vaccine becomes available, but our data are cautious optimism about effective vaccination in diabetics and the general population. It makes the theory possible, “writes Lampasona. San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy, and colleagues.

Results of COVID-19 with exacerbated diabetes and hyperglycemia

The researchers analyzed the presence of three antibodies against multiple SARS-CoV-2 antigens in 509 participants. IgG is evidence of past infections. IgM indicates a more recent or current infection. IgA is involved in the mucosal immune response, such as the nose, where the virus invades the body.

Overall, 452 (88.8%) patients were hospitalized, 79 (15.5%) were admitted to the intensive care unit, and 93 (18.3%) died during follow-up.

Of the 139 diabetics, 90 (17.7% of the study cohort) have already been diagnosed with diabetes and 49 (9.6%) have been newly diagnosed.

Diabetics were older, had a higher body mass index (BMI), and were more likely to have comorbid cardiovascular disease. High blood pressure,and Chronic kidney disease..As it is Previously reported In the case of diabetes and COVID-19, diabetes was also associated with elevated levels of inflammatory biomarkers, hypercoagulation, leukocytosis, and neutrophilia.

In multivariate analysis, diabetic status (hazard ratio) [HR], 2.32; P = .001), fasting blood glucose (P <.001), and glucose fluctuation (P = .002) were all independently associated with increased mortality and ICU admission. And fasting blood glucose was associated with an increased risk of death, even among people without diabetes ()P <.001).

Similar antibody response in patients with and without diabetes

There was a humoral response to SARS-CoV-2 in diabetic patients, with slight differences in timing and antibody titers from non-diabetic patients and was unaffected by glucose levels.

After adjusting for gender, age, and diabetic status and stratifying by duration of symptoms at sampling, SARS-CoV-2 RBD IgG antibody development is associated with improved survival and HR of time to death Was 0.4 (P = .002).

“Of the antibody responses measured, IgG positivity for SARS-CoV-2 spike RBD predicted survival in both the presence and absence of diabetes,” the authors emphasized with diabetics. Showed similar HR (HR, 0.37; P = .013) and no diabetes (HR, 0.43; P = .038).

These data indicate that the mechanism that confirms the association of specific antigen-antibody responses to spike RBD with patient survival in the presence of diabetes and explains the worse clinical outcomes of diabetic patients is independent of antibody response. Is emphasized. ” ..

They further added, “This is evidence that elevated blood glucose levels predict a poor prognosis even in non-diabetic patients, with increased levels of inflammatory biomarkers and hypercoagulation, as well as leukocytosis and neutrophilia. The association supports the speculation that glucose itself is possible. It is an independent bionegative factor that acts as a direct regulator of natural immunity. “

“The increased severity and mortality risk of COVID-19 pneumonia observed in patients with hyperglycemia was not the result of impaired humoral response to SARS-CoV-2.”

“RBD IgG positivity has been associated with a significant protective effect, allowing careful optimism about the efficacy of future vaccines against SARS-COV-2 in diabetic patients,” they reiterate.

The author does not report any relevant financial relationships.

Diabetology. Published online on October 8, 2020. Overview

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