key: cord-1004258-pqniw9r9
authors: Bhattacharjee, Annesh; Khanna, Arjun; Gutch, Manish
title: COVID vaccination in patients with diabetes mellitus: A catch 22 situation?
date: 2022-01-31
journal: J Family Med Prim Care
DOI: 10.4103/jfmpc.jfmpc_1313_21
sha: 5b583a14bb1c342b72f84bf32b95713f7a08e2d9
doc_id: 1004258
cord_uid: pqniw9r9

nan

Dear Editor, Patients with diabetes mellitus who are affected by COVID-19 infection have been shown to have poor outcomes. This results from altered immune response [1] in diabetics and to some extent due to direct damaging effect of hyperglycaemia, [2] thus highlighting the importance of vaccination in diabetics. [3] In India, three different types of vaccines against COVID-19 have been approved so far. [4] The most popular one is Covishield TM which contains the SARS-CoV-2 spike glycoprotein antigen. The second one is COVAXIN comprising of whole-virion inactivated SARSCoV-2 antigen. The latest addition is the Sputnik V that uses a heterologous recombinant adenovirus approach using adenovirus26 (Ad26) and adenovirus 5 (Ad5) as vectors for the expression of the SARS-CoV-2spike protein.

A period of transient hyperglycaemia has been recorded in some diabetic individuals after vaccination. Bhatti et al. [5] reported cases of two individuals whose fasting blood glucose levels got elevated on days 1 and 2 post-vaccination and subsequently settled down by day 3. Similar findings were noted by Mishra et al. [6] in their case series in which the blood glucose levels (fasting and post-prandial) got elevated at day 1 post-vaccination in two individuals whereas another patient exhibited a delayed rise after 6 days of vaccination. The blood glucose levels settled down on days 3, 15 and 30 respectively and required increasing the dose of Metformin in one individual.

Hence clinicians need to be aware of this less common adverse effect of vaccination which has been sporadically reported. [4] A case of hyperosmolar hyperglycaemic state following vaccination has been reported following Pfizer-BioNTechCOVID-19 vaccine.

[7] The vaccine-induced hyperglycaemia is probably due to initial inflammation and subsequent immune response, though further studies are needed in this regard.

Diabetic patients with COVID should be counselled to keep an eye on their blood glucose levels post vaccination. Although most of the instances reported so far are self-limiting, an increase in dosage of oral hypoglycaemic agents or insulin may be needed for a short period of time to combat the deleterious effects of hyperglycaemia in appropriate patients.

The reports of altered glucose control post-vaccination are very few. However, the interaction of Diabetes and COVID, leading to poor outcomes is very well known. Such sporadic case reports should not deter the primary care physician from advocating routine COVID vaccination in all diabetics and other patients, who are at risk of developing diabetes. It is very important to highlight here, that in today's era, where vaccination seems to be the only way out of this mess; reports such as the ones mentioned above are not highlighted by social media and should not be a deterrent for vaccination, especially in the high-risk groups.

Nil.

There are no conflicts of interest.

Manish Gutch 3

Immune response to SARS-CoV-2 infection in obesity and T2D: Literature review

Hyperglycemia and COVID-19: What was known and what is really new?

COVID-19 vaccine prioritisation for type 1 and type 2 diabetes

COVID-19 vaccination in patients with diabetes mellitus: Current concepts, uncertainties and challenges

Acute hyperglycaemia after COVID-19 vaccination in patients with stable diabetes

A case series (Preprint