Correlation between COVID-19 vaccination and diabetes mellitus: A systematic review

Table 2 Summary of the case report or case series about the effect of SARS-CoV-2 vaccination on blood glucose

Ref.	Age (yr)	Gender	Type and name of vaccine	Blood glucose (mg/dL)/HbA1c (%) pre-vaccination post-vaccination		Onset after vaccination	Pre-existing condition	Final diagnosis	C-peptide (ng/mL)	GAD65Ab (IU/mL)	Treatment	Outcomes	Conclusion
Sakurai et al[58]	36	Female	mRNA-BNT162b2 (Pfizer-BioNTech)	Normal	501/7.0	3 d after dose 1	None	Fulminant T1DM	0.13	NA	Insulin infusion	Discharged	mRNA vaccine is associated with new-onset T1DM
Patrizio et al[59]	52	Male	mRNA-BNT162b2 (Pfizer-BioNTech)	531	871	4 wk after dose 2	Vitiligo vulgaris and T2DM	Graves’ disease and T1DM	1	61.2	Insulin analogues	NR	T1DM may be triggered after SARS-CoV-2 vaccination
Aydoğan et al[60]	56	Male	mRNA-BNT162b1 (Pfizer-BioNTech)	Normal	440/8.2	15 d after dose 2	Vitiligo vulgaris and Hashimoto's thyroiditis	T1DM	1.5	> 2000	Insulin infusion	Recovery	Vaccination with BNT162b2 may trigger T1DM
	48	Male	mRNA-BNT162b2 (Pfizer-BioNTech)	Normal	352/10.1	8 wk after dose 2	None	T1DM	0.97	94	Low-carbohydrate diet	Recovery
	27	Male	mRNA-BNT162b2 (Pfizer-BioNTech)	Normal	320/12.5	3 wk after dose 2	None	T1DM	0.87	725	Basal insulin	Recovery
	36	Male	mRNA-BNT162b2 (Pfizer-BioNTech) and CoronaVac	Normal	526/12.6	3 wk after dose 2	None	T1DM	0.38	234	Insulin infusion	Recovery
Sato et al[61]	43	Male	mRNA-based SARS-CoV-2 vaccination	94/5.6	655/8.0	14 d after dose 2	Malignant melanoma	Fulminant T1DM	0.33		Insulin infusion	Discharged	mRNA vaccine may trigger T1DM
Yakou et al[62]	71	Female	mRNA-BNT162b1 (Pfizer-BioNTech)	93/8.1	944/8.0	1 d after dose 2	T1DM	Diabetic ketoacidosis	< 0.03	> 2000	Insulin infusion	Discharged	Risk of inducing ketoacidosis after vaccination in T1DM patients
	52	Female	mRNA-BNT162b1 (Pfizer-BioNTech)	106	494/11.6	1 d after dose 2	T1DM	Diabetic ketoacidosis	ND	123	Insulin infusion	Discharged
Mishra et al[63]	58	Female	Covishield™ (ChAdOx1-nCOV) (AstraZeneca)	110	183	1 d after dose 1	T2DM	T2DM	NR	NR	Increased dose of metformin.	Discharged	Vaccination may result in a mild and temporary increase in blood glucose levels
	64	Male	Covishield™ (ChAdOx1-nCOV) (AstraZeneca)	95	150	1 d after dose 1	T2DM	T2DM	NR	NR	Without additional intervention	Discharged
	65	Male	Covishield™ (ChAdOx1-nCOV) (AstraZeneca)	107	186	6 d after dose 1	T2DM	T2DM	NR	NR	Without additional intervention	Discharged
Abu-Rumaileh et al[64]	58	Male	mRNA-BNT162b1 (Pfizer-BioNTech)	80	1253/13	26 d after dose 1	Hypertension	T2DM	1.1	NR	Insulin infusion	Discharged	COVID-19 vaccine has a risk of causing new-onset T2DM
Sasaki et al[65]	73	Female	Moderna (Spikevax, mRNA-1273)	7.3	318/9.3	8 wk after dose 2	Osteoporosis, mild glucose intolerance	T1DM	0.48	> 2000	Intensive insulin therapy	NR	COVID-19 Vaccination may lead to the new-onset T1DM
Lee et al[66]	52	Female	mRNA-BNT162b2 (Pfizer-BioNTech)	5.5-6.2	1062/12.0	3 d after dose 1	Hypertension	T2DM and nonketotic HHS	NR	NR	Insulin infusion.	Discharged	Vaccination may trigger HHS
	60	Male	Moderna (mRNA-1273)	7.5	847/13.2	2 d after dose 1	T2DM	T2DM and HHS	NR	NR	Insulin infusion	Discharged	Vaccination may trigger a hyperglycemic episode
	87	Male	Moderna (mRNA-1273)	7	923	10 d after dose 1	T2DM	T2DM and HHS and DKA	NR	NR	Insulin infusion	Discharged	Vaccination may trigger HHS and DKA
Edwards et al[67]	59	Male	Covishield™ (ChAdOx1-nCOV)	5.6	594/14.1	21 d after dose 1	Obesity	Hyperglycemic ketosis	2352	NR	NA	Discharged	The first administration of the adenovirus-vectored COVID-19 vaccine can trigger an acute hyperglycemic crisis
	68	Male	Covishield™ (ChAdOx1-nCOV)	6.5	918/14.7	36 d after dose 1	Pre-diabetes	Mixed HHS/DKA	5612	NR	ICU admission	Discharged
	53	Male	Covishield™ (ChAdOx1-nCOV)	6.2	576/17.1	20 d after dose 1	Pre-diabetes	DKA	3772	NR	ICU admission	Discharged
Ganakumar et al[68]	20	Male	COVISHIELD (ChAdOx1 nCoV-19)	NR	14.1	1 d after dose 2.	None	Severe DKA	NR	NR	Insulin infusion	Discharged	COVID-19 vaccination has the potential to induce DKA
	25	Female	COVAXIN (BBV152)	NR	16.3	4 d after dose 2	None	Severe DKA	NR	NR	Insulin infusion	Discharged
Zilbermint et al[69]	24	Female	Moderna (mRNA-1273)	NR	505/12.0	15 h after dose 2	T1DM	Severe DKA	NR	NR	Insulin infusion	NR	A plausible mechanism exists between COVID-19 vaccination and DKA
Yaturu et al[70]	56	Male	BNT162b2 (Pfizer-BioNTech)	5.6	997/14	Right after the second dose.	Hypertension, primary hyperparathyroidism, and obesity	T2DM and HHS	NR	NR	Insulin infusion	Discharged	COVID-19 vaccination has the potential to induce HHS
Kshetree et al[71]	69	Male	mRNA vaccine	5.8	13.7	Two months after dose 3	Hypertension and pre-diabetes	T1DM and DKA	0.4	0.33	Insulin infusion	Discharged	COVID-19 mRNA vaccine has the potential to induce DKA
Prasad[72]	73	Male	Covishield	92/7.1	215/8	6 d after dose 1	T2DM	T2DM	NR	NR	Insulin infusion	Discharged	Vaccination may cause glycaemic disturbances
Sasaki et al[73]	45	Female	BNT162b2 (Pfizer-BioNTech)	Normal	344/7.6	1 d after dose 1	None	Fulminant T1DM and DKA	NR	NA	Insulin infusion	Discharged	COVID-19 vaccine might trigger the onset of fulminant T1DM in susceptible individuals
Yano et al[74]	51	Female	Moderna (mRNA-1273)	Normal	648/10.3	28 d after dose 1	None	Fulminant T1DM and DKA	1.72	NA	Insulin infusion	Discharged	COVID-19 vaccination can induce T1DM in some individuals
Ohuchi et al[75]	45	Male	BNT162b2 (Pfizer-BioNTech)	NR	655	3 d after dose 2	Cutaneous malignant melanoma	Fulminant T1DM	0.99	Negative	NR	NR	There is a highly suspicious causal relationship between fulminant T1DM and vaccination, especially in patients treated with ICI

¹Unit: mmol/mol and reference range is 20-38.

²Unit: pmol/L and the reference range is 370-1470.

NA: Not available; ND: Not detected; NR: Not reported; COVID-19: Coronavirus disease2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; HbA1c: Glycated hemoglobin; DM: Diabetes mellitus; T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; HHS: Hyperosmolar hyperglycemic syndrome; DKA: Diabetic ketoacidosis; ICI: Immune checkpoint inhibitors.