Prevaccination Glucose Time in Range Correlates With Antibody Response to SARS-CoV-2 Vaccine in Type 1 Diabetes

Abstract

Context Poor glucose control has been associated with increased mortality in COVID-19 patients with type 1 diabetes (T1D). Objective To assess the effect of pre-vaccination glucose control on antibody response to the SARS-CoV-2 vaccine BNT162b2 in T1D. Design and methods We studied 26 patients with T1D scheduled to receive two doses, 21 days apart, of BNT162b2, followed prospectively for six months with regular evaluation of SARS-CoV-2 antibodies and glucose control. IgG to spike glycoprotein were assessed by ELISA, and serum neutralization by a live SARS-CoV-2 assay (Vero E6 cells system). HbA1c and continuous glucose monitoring (CGM), including time in range (TIR) and above range (TAR) were collected. Main outcome measures The primary exposure and outcome measures were pre-vaccination glucose control, and antibody response after vaccination, respectively. Results Pre-vaccination HbA1c was unrelated to post-vaccine spike IgG (r = -0.33, p = 0.14). Of note, the CGM profile collected during the two weeks preceding BNT162b2 administration, correlated with post-vaccine IgG response (TIR: r = 0.75; p = 0.02; TAR: r = -0.81; p = 0.008). Patients meeting the recommended pre-vaccination glucose targets of TIR (≥70%) and TAR (≤25%), developed stronger neutralizing antibody titres (p < 0.0001 and p = 0.008, respectively), regardless of HbA1c. Glucose control along the study timeframe was also associated with IgG response during follow-up (TIR: r = 0.93, p < 0.0001; TAR: r = -0.84, p < 0.0001). Conclusions In T1D, glucose profile during the two weeks preceding vaccination is associated with stronger spike antibody binding and neutralization, highlighting a role for well-controlled blood glucose in vaccination efficacy.

Effectiveness of SARS-CoV-2 primary vaccines and boosters in patients with type 2 diabetes mellitus in Hungary (HUN-VE 4 Study)

“…To date, research mainly focused on in vitro, ex vivo or serologic examinations of patients with diabetes regarding the SARS-CoV-2 vaccines, and the results are conflicting: some data suggest that the antibody response to SARS-CoV-2 or SARS-CoV-2 vaccines may be weaker in individuals with DM 35–37. On the other hand, other pieces of evidence support the notion that the immunization due to the infection or vaccination may be as effective in individuals with and without DM, especially if tighter glycemic control is achieved 10 32 38–41…”