Lee Hanna J, Sajan Alen, Tomer Yaron
Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA.
J Endocr Soc. 2021 Sep 25;5(11):bvab141. doi: 10.1210/jendso/bvab141. eCollection 2021 Nov 1.
Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) and new-onset diabetes mellitus (DM) have been reported in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Hyperglycemia is a predictor of poor prognosis in COVID-19 disease.
The objective of this work is to describe a case series of HHS and/or DKA likely triggered by the COVID-19 vaccine. The aim is to alert physicians of the potential hyperglycemic complications from the COVID-19 vaccination and to provide further insight into the underlying mechanism of the bidirectional relationship between SARS-CoV-2 and DM.
All 3 patients developed HHS and/or DKA within 2 to 10 days of the COVID-19 vaccination. PCR testing for SARS-CoV-2 was negative and other clinical precipitating factors were excluded. Two patients had a history of type 2 DM (T2DM) with pre-admission HbA1c levels of 7.0% to 7.5% while 1 patient was newly diagnosed with T2DM during the hospitalization. They were each treated with insulin infusion and were discharged on subcutaneous insulin therapy. Due to the rapid resolution of the hyperglycemia, insulin was discontinued in all patients within 8 weeks and they remain well-controlled on oral DM medications.
Severe hyperglycemia including HHS and DKA may be triggered by COVID-19 vaccination. Early evaluation and screening of patients with hyperglycemic symptoms after COVID-19 vaccination is recommended. The vaccine-induced hyperglycemia may provide further insight into the underlying pathogenesis caused by the SARS-CoV-2 infection itself. The underlying robust inflammatory response and "cytokine storm" may be the primary precipitant.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染中，已报告出现糖尿病酮症酸中毒（DKA）和高渗高血糖综合征（HHS）等高血糖急症以及新发糖尿病（DM）。高血糖是2019冠状病毒病（COVID-19）预后不良的一个预测指标。
本研究旨在描述一系列可能由COVID-19疫苗引发的HHS和/或DKA病例。目的是提醒医生注意COVID-19疫苗接种可能导致的高血糖并发症，并进一步深入了解SARS-CoV-2与DM之间双向关系的潜在机制。
所有3例患者在接种COVID-19疫苗后2至10天内发生HHS和/或DKA。SARS-CoV-2的PCR检测呈阴性，且排除了其他临床诱发因素。2例患者有2型糖尿病（T2DM）病史，入院前糖化血红蛋白（HbA1c）水平为7.0%至7.5%，而1例患者在住院期间新诊断为T2DM。他们均接受了胰岛素输注治疗，并在皮下胰岛素治疗后出院。由于高血糖迅速缓解，所有患者在8周内停用胰岛素，目前通过口服降糖药血糖控制良好。
COVID-19疫苗接种可能引发包括HHS和DKA在内的严重高血糖。建议对COVID-19疫苗接种后出现高血糖症状的患者进行早期评估和筛查。疫苗诱发的高血糖可能有助于进一步深入了解SARS-CoV-2感染本身引起的潜在发病机制。潜在的强烈炎症反应和“细胞因子风暴”可能是主要诱因。
