COVID-19 booster may cause small increase in glucose for some with type 1 diabetes
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Key takeaways:
- Adults with type 1 diabetes may have elevated glucose levels a few days after receiving a COVID-19 booster.
- Researchers said people with type 1 diabetes should closely monitor glucose levels after vaccination.
Adults with type 1 diabetes may have transient increases in glucose levels in the days after receiving a COVID-19 vaccine booster, according to a study published in Diabetes Research and Clinical Practice.
“For the majority of people with type 1 diabetes, the COVID-19 booster does not cause clinically significant effects on glucose levels or control. This is great news,” Andrew P. Demidowich, MD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at Johns Hopkins University School of Medicine, told Healio. “However, in rare cases, people with type 1 diabetes may experience transient glycemic elevations on the day of vaccination and lasting up to 5 days. Therefore, patients and providers should be made aware of this possibility.”
Demidowich and colleagues conducted a single-center prospective study with 21 adults with type 1 diabetes who previously received a primary COVID-19 vaccine series (mean age, 47.4 years; 62% women). Participants were given a masked Dexcom G6 continuous glucose monitor at an initial visit 3 to 4 days before receiving a COVID-19 vaccine booster. A follow-up visit in which the CGM was removed took place 10 days after the initial visit, or 5 to 6 days after receiving the booster. Researchers collected daily mean glucose levels, total daily insulin dose, total daily insulin resistance, total daily basal insulin dose, time in range, time below range, time above range and glycemic variability. Baseline was defined as the day before participants received the booster vaccine.
Glycemic levels increase 2 to 3 days after vaccination
Of the participants, 13 received a Pfizer-BioNTech booster and eight received a Moderna booster. Mean daily glucose increased from 162.9 mg/dL at baseline to 172.8 mg/dL 2 days after vaccination (P = .04) and to 173.1 mg/dL 3 days after vaccination (P = .02). Four participants had at least a 25% increase in glucose on the day of vaccination and 1 day after vaccination compared with baseline. Three participants had at least a 25% elevation in glucose compared with baseline on day 2 and day 5.
Insulin resistance increased in the study group from baseline to day 2 (P = .03). No other glycemic measures changed after vaccination compared with before vaccination. There were also no changes in outcome measures after stratifying the study population by sex, age or vaccine manufacturer.
“Vaccinations are designed to stimulate the immune system, leading to an inflammatory response,” researcher Mihail Zilbermint, MD, MBA, FACE, associate professor of clinical medicine at Johns Hopkins University School of Medicine and chief and director of endocrinology, diabetes and metabolism at Suburban Hospital in Bethesda, Maryland, told Healio. “Inflammation can have a significant impact on glucose regulation. It may lead to insulin resistance, where the body’s cells become less responsive to insulin, resulting in higher blood glucose levels. The production of cytokines as part of the immune response can influence glucose metabolism. Some cytokines may impair insulin sensitivity, potentially contributing to elevated blood glucose levels.”
Monitoring of glycemic levels crucial after vaccination
Demidowich and Zilbermint said providers should reinforce treatment plans for hyperglycemia among adults with type 1 diabetes who are getting a COVID-19 booster and also provide information on the potential for fluctuating glucose levels.
“Individuals with type 1 diabetes should not hesitate to receive a COVID-19 booster vaccine when eligible,” Zilbermint said. “While some may experience temporary changes in blood glucose levels, being proactive, monitoring and adjusting insulin doses as needed can help manage these fluctuations effectively. Consultation with health care providers remains crucial for personalized guidance. The overarching message is that vaccination remains a critical tool in reducing the risk of severe COVID-19 complications for individuals with type 1 diabetes.”
Demidowich said more studies are needed to analyze how other types of vaccines may affect glucose levels for people with type 1 diabetes.
“Although studies on COVID-19 vaccines and glycemia thankfully did not demonstrate clinically significant hyperglycemic effects, the same might not be true for other commonly administered vaccines such as influenza, Tdap or pneumococcal,” Demidowich said. “Moreover, it would be valuable to understand which patient populations may be more susceptible to severe post-vaccination hyperglycemia or diabetes ketoacidosis.”
For more information:
Andrew P. Demidowich, MD, can be reached at ademido1@jhmi.edu.
Mihail Zilbermint, MD, MBA, can be reached at mzilber3@jhmi.edu.
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