对 COVID-19 疫苗接种后 1 型糖尿病患者连续血糖监测数据的分析揭示了免疫和代谢反应之间出人意料的联系，辅助口服药物治疗后这种联系得到增强。
Analysis of continuous glucose tracking data in people with type 1 diabetes after COVID-19 vaccination reveals unexpected link between immune and metabolic response, augmented by adjunctive oral medication.
机构信息
The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.
出版信息
Int J Clin Pract. 2021 Dec;75(12):e14714. doi: 10.1111/ijcp.14714. Epub 2021 Oct 7.
INTRODUCTION
The COVID-19 vaccination programme is under way worldwide. Anecdotal evidence is increasing that some people with type 1 diabetes mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before/after vaccination.
METHODS
We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage (%) BG readings in the designated target range 3.9-10 mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1).
RESULTS
There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ± SE 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ± SE 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1%-13.9%/≥14%. There was no significant change in BG variability in the 7days post-COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal-bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)).
CONCLUSION
In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may also have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.
引言
全球范围内正在开展 COVID-19 疫苗接种计划。越来越多的传闻证据表明，一些 1 型糖尿病（T1DM）患者在接种疫苗后会出现短暂的血糖（BG）水平不稳定，通常会在 2-3 天内恢复正常。我们报告了对 20 名个体接种前后 BG 谱的分析。
方法
我们使用 FreeStyle Libre 闪光血糖监测仪在 COVID-19 疫苗接种前后即刻检查了 20 名连续的成年 T1DM 患者的 BG 谱。主要观察指标是接种疫苗前一周（周-1）和接种疫苗后一周（周+1）通过 LibreView 门户报告的指定目标范围内（3.9-10mmol/L）的 BG 读数百分比（%）。
结果
接种 COVID 疫苗后的 7 天内，%BG 明显低于接种疫苗前（平均 45.2%±SE 4.2%），而接种 COVID-19 疫苗前（平均 52.6%±SE 4.5%）。这与其他 BG 类别（10.1%-13.9%/≥14%）的读数比例增加相吻合。接种 COVID-19 疫苗后 7 天内 BG 变异性无显著变化。接种疫苗后一周内，BG 比例在目标范围内的这种变化在服用二甲双胍/达格列净+基础-餐时胰岛素的患者中最为明显（-23%），与未服用口服降糖药的患者相比（-4%），年龄中位数<53 岁与≥53 岁（年龄较大的个体在目标范围内的 BG 减少更明显（-18%比-9%））。
结论
在 T1DM 中，我们已经表明 COVID-19 疫苗接种会导致 BG 暂时波动，这种影响在服用口服降糖药加胰岛素的患者和年龄较大的患者中更为明显。这也可能对目前未接受闪光血糖监测的 T2DM 患者产生影响。
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