Time in glucose target range may decline after COVID-19 vaccine in type 1 diabetes
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The first dose of a COVID-19 vaccine can cause a decline in interstitial glucose time in range for adults with type 1 diabetes, according to study findings published in Diabetic Medicine.
“COVID-19 vaccination can cause temporary perturbation of interstitial glucose in people with type 1 diabetes, with this effect more pronounced in those people with better pre-vaccination blood glucose control, but no difference in effect between the Pfizer-BioNTech Oxford-AstraZeneca COVID-19 vaccines,” Adrian H. Heald, MD, consultant at Salford Royal Hospital in the U.K. and lecturer at the University of Manchester, and colleagues wrote. “This finding is of relevance to people with type 1 diabetes and to clinicians.”
Researchers analyzed data from 97 consecutive adults (median age, 44 years; 52.5% women) with type 1 diabetes cared for at the NHS specialist diabetes service in East Cheshire, U.K., who received the first dose of a COVID-19 vaccine and used the Abbott FreeStyle Libre 7 days before vaccination and 7 days after. Percentage of time in range with interstitial glucose between 3.9 mmol/L and 10 mmol/L was the primary outcome in the study. Researchers also obtained mean interstitial glucose and glucose variability data.
Participants received either the Pfizer-BioNTech (n = 45) or Oxford-AstraZeneca (n = 52) vaccine. Participants had a decrease in time in range from 55% 7 days before vaccination to 52.2% 7 days after vaccination (P = .03). Time in range decreased for 58% of participants after vaccination compared with before, 30% had a decrease in time in range of more than 10%, and about 10% had time in range decline more than 20%. However, there was no significant change observed in glucose variability after vaccination compared with before vaccination.
Time in range decreased 5.7% for participants with an HbA1c lower than the cohort’s median compared with no change for those with a higher HbA1c (P = .007). Adults using adjunctive oral diabetes medications had a 7.6% reduction in time in range compared with a 2.9% decline in those using only insulin (P = .009). Of 49 participants with HbA1c of less than 7.3%, 32 had a decrease in time in range and 18 had a time in range decline of more than 10%. Of 13 participants using oral medication and insulin and with an HbA1c of less than 7.3%, 10 had a decline in time in range and six had time in range decrease more than 10%.
“The finding that there was a greater reduction in the proportion of interstitial glucose readings on target for people with a lower HbA1c may indicate that these individuals were more sensitive to the effects of vaccination on interstitial glucose levels,” the researchers wrote. “In essence they had ‘more to lose’ in terms of what in some individuals was already a high proportion of interstitial glucose readings on target.”
The researchers noted clinical data support a robust antibody response for people with type 1 diabetes receiving the COVID-19 vaccine and the findings should not dissuade those with diabetes from getting vaccinated. However, they said providers should prepare patients with type 1 diabetes for possible transient hyperglycemia after vaccination.
“A larger, multisite patient series is necessary to investigate this further,” the researchers wrote. “However, the results here raise the question of whether people with type 1 diabetes should be given specific advice in advance of COVID-19 booster vaccination in relation to potential temporary effects on their glycemic control.”
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