Only Subclinical Alterations in the Haemostatic System of People with Diabetes after COVID-19 Vaccination

Abstract

People with diabetes have an increased risk of experiencing adverse COVID-19 outcomes. COVID-19 vaccination is, therefore, highly recommended. However, people with diabetes have an inherently elevated risk of thrombotic events and the impact of the vaccination on the coagulation system in this patient population remains to be elucidated. The aim of this study was to investigate the impact of COVID-19 vaccination on the haemostatic system in people with type 1 or type 2 diabetes. We evaluated the effects of COVID-19 vaccination (BioNTech Pfizer, Moderna, AstraZeneca) on standard coagulation parameters, whole blood coagulation (Thrombelastometry), platelet function (impedance aggregation), and thrombin generation (calibrated automated thrombography) in people with type 1 diabetes mellitus (n = 41) and type 2 diabetes mellitus (n = 37). Blood sampling points were prior to vaccination and two weeks after the respective vaccination. Thrombelastometry measurements indicated moderately increased clot formation post-vaccination in people with type 1, as well as with type 2, diabetes: “Clot formation times” were significantly shorter, and both “maximum clot firmness” and “alpha angles” were significantly higher, as compared to the respective pre-vaccination values. Therefore, TEM parameters were not altered after vaccination in patients receiving ASA. Moreover, platelet aggregation was enhanced in people with type 1 diabetes, and plasma levels of D-Dimer were increased in people with type 2 diabetes, following COVID-19 vaccination. All other standard coagulation parameters, as well as thrombin generation, were not affected by the vaccination. The coagulation responses of people with diabetes to COVID-19 vaccination were only subclinical and comparable to those observed in healthy individuals. Our findings suggest that people with diabetes do not face an increased activation of the coagulation post-vaccination.

Molecular Mechanisms Responsible for Diabetogenic Effects of COVID-19 Infection—Induction of Autoimmune Dysregulation and Metabolic Disturbances

“…Finally, a recent prospective cohort study conducted in the USA confirmed these findings and further showed that T1DM patients had a higher risk of hospitalization for COVID-19 than T2DM patients [57]. It should not be neglected that SARS-CoV-2 patients with diabetes are more prone to the development of severe clinical presentation [58,59], as well as the complicated course of the disease, especially when they are not regulated properly. A large prospective cohort study that included 9058 patients in Romania showed that patients with T2DM were associated with higher intensive care unit mortality [60].…”

“…Furthermore, there are reports about more frequent adverse reactions to the vaccines with diabetic patients [118,119], but other researchers did not find such a relation [58]. There were concerns that, since diabetes mellitus is a procoagulatory state, vaccines could precipitate thromboembolic incidents, but a study investigating coagulation pathways in T1DM and T2DM patients after vaccination did not find significant differences compared to healthy individuals [59]. Vaccines not only reduce the chance of severe clinical presentation and hospital admission in diabetic patients [120] but could also have a protective effect and reduce the possibility of developing diabetes mellitus after COVID-19 in healthy individuals [108,121].…”