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World J Diabetes. Sep 15, 2022; 13(9): 738-751
Published online Sep 15, 2022. doi: 10.4239/wjd.v13.i9.738
Effectiveness and safety of COVID-19 vaccines in patients with diabetes as a factor for vaccine hesitancy
Georgi Vasilev, Plamena Kabakchieva, Dimitrina Miteva, Hristiana Batselova, Tsvetelina Velikova
Georgi Vasilev, Faculty of Medicine, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Plamena Kabakchieva, Clinic of Endocrinology, University Hospital “Alexandrovska,” Department of Internal Medicine, Medical Faculty, Medical University, Sofia 1431, Bulgaria
Plamena Kabakchieva, Clinic of Internal Diseases, Naval Hospital-Varna, Military Medical Academy, Varna 9010, Bulgaria
Dimitrina Miteva, Department of Genetics, Sofia University “St. Kliment Ohridski,” Faculty of Biology, Sofia 1164, Bulgaria
Hristiana Batselova, Department of Epidemiology and Disaster Medicine, Medical University, University Hospital “St George,” Plovdiv 4000, Bulgaria
Tsvetelina Velikova, Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Tsvetelina Velikova, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Author contributions: Velikova T and Vasilev G contributed to the conceptualization; Vasilev G, Kabakchieva P, Miteva D, Batselova H, and Velikova T contributed to the investigation; Miteva D and Kabakchieva P contributed to the resources; Vasilev G and Miteva D wrote the original draft; Kabakchieva P, Batselova H and Velikova T wrote and editing the manuscript; Velikova T contributed to the supervision; all authors revised and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsvetelina Velikova, MD, PhD, Assistant Professor, Chief Doctor, Department of Clinical Immunology, University Hospital Lozenetz, Kozyak 1 Str., Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Received: March 27, 2022
Peer-review started: March 27, 2022
First decision: May 11, 2022
Revised: June 6, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 15, 2022
Processing time: 166 Days and 5.3 Hours
Abstract

Diabetes mellitus is one of the most common comorbid conditions encountered in patients with severe acute respiratory syndrome coronavirus 2 infection accompanied by significantly increased mortality, prolonged hospital stay, and requirement of invasive mechanical ventilation. This review aims to present the effectiveness and safety profile of available coronavirus disease 2019 (COVID-19) vaccines in people with diabetes as a potential cause of hesitancy for vaccination. Data from published research proves a robust immune response following immunization for COVID-19 in diabetic patients with substantial production of virus-neutralizing antibodies; however, the observed immune response was unequivocally weaker than that in individuals without diabetes. This observation was further enhanced by the findings that worse glycemic control was associated with more suppressed antibody production. In contrast, individuals with optimal glycemic control performed similarly to healthy controls. In addition to the need for strict glucose monitoring and adequate diabetes treatment, those findings reinforce the concept of diabetes-induced secondary immune deficiency and necessitate the application of booster doses to diabetic patients with priority. Nevertheless, after vaccination, reported adverse events were not different from those in the general population. No increase in severe adverse events was documented. While single case reports detected transient increases in blood glucose post-vaccination, more extensive trials could not replicate such a relationship.

Keywords: COVID-19; COVID-19 vaccines; Diabetes; Vaccine effectiveness; Vaccine; Vaccine hesitancy

Core Tip: Diabetes mellitus is a crucial contributor to coronavirus disease 2019 (COVID-19). This review highlights published research on the effectiveness of vaccination against COVID-19 and related adverse events. Despite data of a notable decrease in the immune response to vaccination of diabetic patients, studies point out the importance of strict glycemic control to achieve adequate immunity against severe acute respiratory syndrome coronavirus 2 and the need to prioritize people with diabetes for the administration of booster doses. Regarding adverse events, none were increased in frequency in the diabetic population, except sporadic transient hyperglycemia observed post-vaccination.