School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Diabetes Obes Metab. 2023 Sep;25(9):2734-2742. doi: 10.1111/dom.15163. Epub 2023 Jun 13.
To explore the risk of breakthrough infection among patients with type 2 diabetes (T2D) and risk of severe clinical outcomes after SARS-CoV-2 infection according to vaccination status.
We conducted a population-based cohort study using South Korea's linked database of nationwide COVID-19 registry and claims data between 2018 and 2021. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breakthrough infections were measured in 1:1 propensity-score (PS)-matched fully vaccinated patients with versus without T2D (full-vaccination cohort), and HRs for all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) use, and hospitalizations after SARS-CoV-2 infection were measured in 1:1 PS-matched T2D patients with versus without full-vaccination (T2D cohort).
After 1:1 PS matching, 2 109 970 patients with and without T2D were identified (age 63.5 years; 50.9% male). Patients with T2D showed an increased risk of breakthrough infections compared to those without T2D (HR 1.10, 95% CI 1.06-1.14). The increased risk of breakthrough infections was more notable among T2D patients receiving insulin treatment. However, the risk of severe COVID-19 outcomes was lower in fully vaccinated T2D patients compared with unvaccinated T2D patients (all-cause mortality: HR 0.54, 95% CI 0.43-0.67; ICU admission/MV use: HR 0.31, 95% CI 0.23-0.41; hospitalization: HR 0.73, 95% CI 0.68-0.78).
While patients with T2D remain a vulnerable population to SARS-CoV-2 infection even after full-vaccination, full-vaccination was associated with a lower risk of adverse clinical outcomes after SARS-CoV-2 infection. These findings support the guidelines recommending patients with T2D as a priority vaccination group.
根据接种状况，探讨 2 型糖尿病（T2D）患者突破性感染的风险以及 SARS-CoV-2 感染后严重临床结局的风险。
我们进行了一项基于人群的队列研究，使用了韩国 2018 年至 2021 年期间全国 COVID-19 登记和理赔数据的关联数据库。在 1:1 倾向评分（PS）匹配的完全接种疫苗的 T2D 患者与未患 T2D 的患者（完全接种疫苗队列）中，测量了突破性感染的风险比（HR）和 95%置信区间（CI），在 1:1 PS 匹配的 T2D 患者与未完全接种疫苗的患者（T2D 队列）中，测量了全因死亡率、重症监护病房（ICU）入院/机械通气（MV）使用和 SARS-CoV-2 感染后的住院治疗的 HR。
经过 1:1 PS 匹配，共确定了 2109970 名患有和未患有 T2D 的患者（年龄 63.5 岁；50.9%为男性）。与未患 T2D 的患者相比，患有 T2D 的患者发生突破性感染的风险更高（HR 1.10，95%CI 1.06-1.14）。接受胰岛素治疗的 T2D 患者发生突破性感染的风险增加更为显著。然而，与未接种疫苗的 T2D 患者相比，完全接种疫苗的 T2D 患者发生严重 COVID-19 结局的风险较低（全因死亡率：HR 0.54，95%CI 0.43-0.67；ICU 入院/MV 使用：HR 0.31，95%CI 0.23-0.41；住院治疗：HR 0.73，95%CI 0.68-0.78）。
尽管 T2D 患者即使完全接种疫苗后仍然是 SARS-CoV-2 感染的脆弱人群，但完全接种疫苗与 SARS-CoV-2 感染后不良临床结局的风险降低相关。这些发现支持将 T2D 患者作为优先接种疫苗人群的指南建议。
