Lamichhane Pratik, Khalid Hussain, Siviyachan Cijoy Kanatte, Zafar Summiya, Prasanth Mahesh, Khanal Kapil, Agrawal Anushka, Kaur Jhajj Loveleen
Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
Department of Internal Medicine, Darlington Memorial Hospital, UK.
Ann Med Surg (Lond). 2024 Jan 25;86(3):1613-1621. doi: 10.1097/MS9.0000000000001752. eCollection 2024 Mar.
COVID-19 vaccination is recommended in diabetic patients since diabetes is associated with worse clinical outcomes in COVID-19 infection. The safety profile of different types of COVID-19 vaccines, especially on glycemic control, can be explored due to availability of data from continuous glucose monitoring (CGM) devices. This meta-analysis aimed to quantify the impact of COVID-19 vaccination on glycemic control in patients with type 1 diabetes mellitus (T1DM).
A systematic search of PubMed, Embase, and Google Scholar was conducted using a search strategy for studies published till January 2023 in English language. Comparative observational studies reporting glycemic control obtained from CGM before and after COVID-19 vaccination in T1DM patients were included. The primary outcome was time in range (TIR) metric of proportion of glucose results falling within the range: 3.9-10 mmol/l. Other outcomes were time above range (TAR) (>10 mmol/l), time below range (TBR) (<3.9 mmol/l), coefficient of variation (CV), and mean blood glucose levels. The pooled outcomes were compared pre-vaccination and post-vaccination using Hedges' g (HG) with 95% CI.
A total of seven studies (632 participants) were included in the meta-analysis. COVID-19 vaccination caused small and statistically insignificant decrease in TIR after both the first (HG = 0.21, 95% CI: -0.02 to 0.44, =0.07) and second dose (HG = 0.09, 95% CI: -0.04 to 0.21, = 0.19). Likewise, TAR was not affected after neither first (HG = -0.09, 95% CI: -0.22 to 0.03, = 0.12) nor second vaccine dose (HG = -0.07, 95% CI: -0.21 to 0.06, = 0.30). Likewise, TBR, mean blood glucose levels, and CV were not significantly altered following uptake of either of the doses.
COVID-19 vaccination has an excellent safety profile in T1DM patients owing to its minimal impacts on immediate glycemic control.
由于糖尿病与新冠病毒感染（COVID-19）的较差临床结局相关，因此建议糖尿病患者接种COVID-19疫苗。鉴于连续血糖监测（CGM）设备可提供数据，故可探讨不同类型COVID-19疫苗的安全性，尤其是对血糖控制的影响。本荟萃分析旨在量化COVID-19疫苗接种对1型糖尿病（T1DM）患者血糖控制的影响。
采用检索策略对截至2023年1月发表的英文研究进行系统检索，检索数据库包括PubMed、Embase和谷歌学术。纳入报告T1DM患者接种COVID-19疫苗前后通过CGM获得的血糖控制情况的比较观察性研究。主要结局是血糖结果落在3.9-10 mmol/L范围内的时间范围（TIR）指标。其他结局包括高于范围时间（TAR）（>10 mmol/L）、低于范围时间（TBR）（<3.9 mmol/L）、变异系数（CV）和平均血糖水平。使用Hedges' g（HG）及其95%置信区间（CI）对疫苗接种前和接种后的汇总结局进行比较。
本荟萃分析共纳入7项研究（632名参与者）。接种COVID-19疫苗后，首次接种（HG = 0.21，95%CI：-0.02至0.44，P = 0.07）和第二次接种后（HG = 0.09，95%CI：-0.04至0.21，P = 0.19），TIR均出现小幅下降，但在统计学上无显著差异。同样地，首次接种（HG = -0.09，95%CI：-0.22至0.03，P = 0.12）和第二次接种疫苗后（HG = -0.07，95%CI：-0.21至0.06，P = 0.30），TAR均未受到影响。同样，接种任何一剂疫苗后，TBR、平均血糖水平和CV均无显著变化。
COVID-19疫苗对T1DM患者的即时血糖控制影响极小，因此具有良好的安全性。
