He Yan-Fei, Ouyang Jing, Hu Xiao-Dong, Wu Ni, Jiang Zhi-Gang, Bian Ning, Wang Jie
Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
Casualty Management Section, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
World J Diabetes. 2023 Jun 15;14(6):892-918. doi: 10.4239/wjd.v14.i6.892.
Coronavirus disease 2019 (COVID-19) is one of the current global public health threats and vaccination is the most effective tool to reduce the spread and decrease the severity of COVID-19. Diabetes is one of the important chronic diseases threatening human health and is a common comorbidity of COVID-19. What is the impact of diabetes on the immunization effect of COVID-19 vaccination? Conversely, does vaccination against COVID-19 exacerbate the severity of pre-existing diseases in patients with diabetes? There are limited and conflicting data on the interrelationship between diabetes and COVID-19 vaccination.
To explore the clinical factors and possible mechanisms underlying the interaction between COVID-19 vaccination and diabetes.
We conducted a comprehensive search of PubMed, MEDLINE, EMBASE, and (https://www.referencecitationanalysis.com) online databases, and medRxiv and bioRxiv gray literature using the keywords "SARS-CoV-2", "COVID-19", "vaccine", "vaccination", "antibody", and "diabetes" individually or in combination, with a cut-off date of December 2, 2022. We followed inclusion and exclusion criteria and after excluding duplicate publications, studies with quantifiable evidence were included in the full-text review, plus three manually searched publications, resulting in 54 studies being included in this review.
A total of 54 studies were included, from 17 countries. There were no randomized controlled studies. The largest sample size was 350963. The youngest of the included samples was 5 years old and the oldest was 98 years old. The included population included the general population and also some special populations with pediatric diabetes, hemodialysis, solid organ transplantation, and autoimmune diseases. The earliest study began in November 2020. Thirty studies discussed the effect of diabetes on vaccination, with the majority indicating that diabetes reduces the response to COVID-19 vaccination. The other 24 studies were on the effect of vaccination on diabetes, which included 18 case reports/series. Most of the studies concluded that COVID-19 vaccination had a risk of causing elevated blood glucose. A total of 12 of the 54 included studies indicated a "no effect" relationship between diabetes and vaccination.
There is a complex relationship between vaccination and diabetes with a bidirectional effect. Vaccination may contribute to the risk of worsening blood glucose in diabetic patients and diabetic patients may have a lower antibody response after vaccination than the general population.
2019冠状病毒病（COVID-19）是当前全球公共卫生威胁之一，接种疫苗是减少COVID-19传播和降低其严重程度的最有效工具。糖尿病是威胁人类健康的重要慢性病之一，也是COVID-19的常见合并症。糖尿病对COVID-19疫苗接种的免疫效果有何影响？反之，COVID-19疫苗接种是否会加重糖尿病患者原有疾病的严重程度？关于糖尿病与COVID-19疫苗接种之间的相互关系，现有数据有限且相互矛盾。
探讨COVID-19疫苗接种与糖尿病相互作用的临床因素及可能机制。
我们使用关键词“SARS-CoV-2”“COVID-19”“疫苗”“疫苗接种”“抗体”和“糖尿病”，单独或组合对PubMed、MEDLINE、EMBASE和（https://www.referencecitationanalysis.com）在线数据库以及medRxiv和bioRxiv灰色文献进行全面检索，截止日期为2022年12月2日。我们遵循纳入和排除标准，在排除重复发表的文献后，将具有可量化证据的研究纳入全文综述，另外还人工检索了3篇文献，最终54项研究被纳入本综述。
共纳入来自17个国家的54项研究。没有随机对照研究。最大样本量为350963。纳入样本中最年轻的5岁，最年长的98岁。纳入人群包括普通人群以及一些患有儿童糖尿病、血液透析、实体器官移植和自身免疫性疾病的特殊人群。最早的研究始于2020年11月。30项研究讨论了糖尿病对疫苗接种的影响，大多数研究表明糖尿病会降低对COVID-19疫苗接种的反应。另外24项研究是关于疫苗接种对糖尿病的影响，其中包括18篇病例报告/系列。大多数研究得出结论，COVID-19疫苗接种有导致血糖升高的风险。54项纳入研究中共有12项表明糖尿病与疫苗接种之间存在“无影响”关系。
疫苗接种与糖尿病之间存在复杂的双向关系。疫苗接种可能会增加糖尿病患者血糖恶化的风险，糖尿病患者接种疫苗后的抗体反应可能低于普通人群。
