COVID-19 Vaccines and Patients With Diabetes

Introduction:

The novel Coronavirus disease has affected millions of people globally, especially with a poor prognosis in patients with diabetes mellitus. Diabetes patients with COVID-19 are associated with, severe disease, intensive care unit admissions and increased mortality.

Patients with both type 1 and type 2 diabetes mellitus have an increased vulnerability to COVID-19 disease than people without diabetes mellitus. In addition, even if there was good glycemic control before hospital admission, there was not a consistent improvement in patients with diabetes mellitus admitted with COVID-19. Thus, primary prevention for COVID-19 patients with diabetes mellitus is the mainstay to make it less severe and, getting vaccinated within the appropriate time interval is considered an important step of primary prevention.

Routine vaccination is recommended in patients with diabetes mellitus against,

• Pneumococcal pneumonia.

• Influenza.

• Hepatitis B.

Previously, it was said that patients with diabetes mellitus had a weakened antibody response to influenza and hepatitis B vaccines. But with recent advances in the development of vaccines, people with diabetes mellitus are able to get an appropriate immune response post-vaccination. As people with diabetes mellitus carry the burden of the disease, they are prioritized with COVID-19 vaccinations.

Why Diabetic Patients Are at a Higher Risk of Having COVID-19 Infection?

Diabetic patients are known to have a greater risk of developing infections, such as skin infections, genito-urinary tract infections, and respiratory tract infections. Hyperglycemia in diabetic patients through several pathways favors immune dysfunction. Decreased production of interleukins in response to an infection and reduced phagocytic and chemotaxis activity are the most important underlying mechanisms. Hyperglycemia increases the virulence of certain viruses and bacteria. Clinical reports suggest that diabetes mellitus is one of the most common comorbidities in patients with COVID-19 infection. Diabetic patients have a high risk of infection as well as an increased incidence of hospitalization. Clinical reports suggest that diabetes mellitus is one of the most common comorbidities in patients with COVID-19 infection.

Getting vaccinated with COVID-19 in patients with diabetes mellitus depends on the place we live. The Centers for Disease Control and Prevention (CDC) has made recommendations on who are of utmost priority for vaccinations. Each state plans according to these recommendations and distributes the vaccines to each resident.

Some states offer vaccines to people above 16 years of age, including those with diabetes. Due to the availability of vaccines, CDC has recommended vaccines for all people including those with type 2 diabetes and other underlying medical conditions

Initially the American Diabetes Association (ADA) prioritized vaccines for type 1 and type 2 diabetes mellitus equally as both groups had a similar increased risk for dangerous COVID-19 disease. Earlier decisions on vaccination priority were made by each state but as of now with increased production of vaccines, they are made available for everyone. Few nations have started administering COVID-19 vaccines even to children.

Why Is It Important to Get Vaccinated if Suffering From Diabetes Mellitus?

The immune response to vaccines is important for people with diabetes mellitus as they are at increased risk for developing serious COVID-19 disease. It is said that people with diabetes do much worse than people without diabetes from the following outcomes of COVID-19,

• Roughly half of the people who died from COVID-19 under 65 years of age had diabetes.

• People with type 1 or type 2 diabetes are,

1. More likely to be hospitalized or experience the severe illness of COVID-19 when compared with people without diabetes.

2. More likely to die from COVID-19 in the hospital than people without diabetes.

3. More likely to die or to be treated in the intensive care unit for COVID-19.

So, depending on the area a person lives in, know the availability of the vaccine from a healthcare provider. Also, health departments, pharmacies, doctor offices, and hospitals play a major role in administering vaccines.

Is the COVID Vaccine Safe for People With Diabetes?

Currently, there are 38 approved vaccines (that are approved by different national Government bodies) and ten vaccines that are listed by WHO (World Health Organization) for Emergency Use Listing (EUL). The vaccines granted Emergency Use Listing (EUL) by WHO are:

• Sputnik V (Gamaleya).
• Covilo (Sinopharm).
• CoronaVac (Sinovac).
• Ad26.COV2.S (Johnson & Johnson).
• Spikevax (Moderna).
• Comirnaty (Pfizer and BioNTechv).
• Covaxin (Bharat Biotech).
• Covovax and Covishield (Serum Institute of India).
• Nuvaxovid (Novovax).
• Vaxzevria (Oxford/AstraZeneca).

The COVID-19 vaccines are safe for people with type 1 or type 2 diabetes, prediabetes, or gestational diabetes. The vaccines were approved by the United States Food and Drug Administration under an emergency use authorization. To be approved, vaccines must go through a rigorous trial process that includes several phases addressing safety and efficacy. However, the data on immune response in diabetic patients with COVID-19 are scarce. A few prominent clinical trials have been done to test the safety of these vaccines in adults of all ages, as well as chronic health conditions. These include:

• The Pfizer-BioNtech trial included 3,100 people with diabetes. It is an mRNA vaccine with 95 % effectiveness at preventing COVID with symptoms.

• The Moderna trial included 2,800 people with type 1, type 2, and gestational diabetes. It is an mRNA vaccine with 94 % effectiveness at preventing COVID with symptoms.

• The Johnson and Johnson trial included 3,300 people with type 1 and 2 diabetes. It is a viral vector with 66 % effectiveness at preventing COVID with symptoms and 85 % effectiveness against severe COVID-19 illness.

What Are the Side Effects of the COVID Vaccine That Diabetes Patients Should Pay Attention To?

In general, side effects in patients with diabetes mellitus following vaccination are usually mild. But some people have more severe adverse effects that can interfere with their daily activities.

The Most Common Side Effects are,

• Pain.

• Swelling.

• Redness at the injection site.

Other Common Side Effects are,

• Chills.

• Tiredness.

• Headaches.

It is said that the side effects of the COVID-19 vaccines are similar to flu vaccines, and no severe allergic reactions were reported. So, patients with diabetes should monitor their blood glucose levels and have extra medications with a sick day kit as it would be beneficial when feeling unwell.

Vaccines Affecting Blood Glucose Levels:

As vaccines cause symptoms of illness and can lead to high glucose levels, it is important to monitor the blood glucose levels carefully for 48 hours after vaccination. Also, stay hydrated and have a sick day plan ready as people with diabetes show few side effects and minor effects on blood sugar levels.

Diabetic Medications Affecting the Vaccine:

Till now, there is no information on drug interactions between COVID vaccines and other medications. However, the vaccine is not expected to interact with Insulin or other standard diabetes medications. Also, avoid the following for several days after vaccination on the vaccine injection site,

• Injecting Insulin.

• Placing a glucose sensor.

• Pump infusion.

Conclusion:

When receiving the COVID vaccine, the healthcare professional will provide a paper card, which helps to know about the name of the vaccine received, the date, and the place of vaccination. Also, it provides information about the vaccine, its benefits, and its side effects. After the injection, the healthcare professional will make the person stay for some time to monitor the bodily reactions.

After receiving both doses of the vaccine, still, it is important to follow COVID safety protocols like wearing a face mask that fits you, avoiding close contact with people, social distancing for at least two meters, wash your hands, monitoring the health, and avoiding touching the face, especially eyes, nose, and mouth. Continue to follow these measures to protect others and yourself from beating the pandemic.