Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2023; 14(6): 892-918
Published online Jun 15, 2023. doi: 10.4239/wjd.v14.i6.892
Correlation between COVID-19 vaccination and diabetes mellitus: A systematic review
Yan-Fei He, Jing Ouyang, Xiao-Dong Hu, Ni Wu, Zhi-Gang Jiang, Ning Bian, Jie Wang
Yan-Fei He, Ni Wu, Ning Bian, Jie Wang, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Jing Ouyang, Casualty Management Section, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Xiao-Dong Hu, Department of Endocrinology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Zhi-Gang Jiang, Department of Statistics, Zunyi Medical University, Zunyi 563006, Guizhou Province, China
Author contributions: He YF designed the study, reviewed literature, and drafted the manuscript; Ouyang J, Hu XD and Wu N retrieved and summarized the literature; Jiang ZG, Bian N and Wang J advised on the review and reviewed the final manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Yan-Fei He, MD, Associate Chief Physician, Doctor, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, No. 6 Fu Cheng Road, Haidian District, Beijing 100048, China. heyanfeilc@163.com
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: March 28, 2023
Revised: April 5, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: June 15, 2023
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) is one of the current global public health threats and vaccination is the most effective tool to reduce the spread and decrease the severity of COVID-19. Diabetes is one of the important chronic diseases threatening human health and is a common comorbidity of COVID-19. What is the impact of diabetes on the immunization effect of COVID-19 vaccination? Conversely, does vaccination against COVID-19 exacerbate the severity of pre-existing diseases in patients with diabetes? There are limited and conflicting data on the interrelationship between diabetes and COVID-19 vaccination.

AIM

To explore the clinical factors and possible mechanisms underlying the interaction between COVID-19 vaccination and diabetes.

METHODS

We conducted a comprehensive search of PubMed, MEDLINE, EMBASE, and Reference Citation Analysis (https://www.referencecitationanalysis.com) online databases, and medRxiv and bioRxiv gray literature using the keywords "SARS-CoV-2", "COVID-19", "vaccine", "vaccination", "antibody", and "diabetes" individually or in combination, with a cut-off date of December 2, 2022. We followed inclusion and exclusion criteria and after excluding duplicate publications, studies with quantifiable evidence were included in the full-text review, plus three manually searched publications, resulting in 54 studies being included in this review.

RESULTS

A total of 54 studies were included, from 17 countries. There were no randomized controlled studies. The largest sample size was 350963. The youngest of the included samples was 5 years old and the oldest was 98 years old. The included population included the general population and also some special populations with pediatric diabetes, hemodialysis, solid organ transplantation, and autoimmune diseases. The earliest study began in November 2020. Thirty studies discussed the effect of diabetes on vaccination, with the majority indicating that diabetes reduces the response to COVID-19 vaccination. The other 24 studies were on the effect of vaccination on diabetes, which included 18 case reports/series. Most of the studies concluded that COVID-19 vaccination had a risk of causing elevated blood glucose. A total of 12 of the 54 included studies indicated a "no effect" relationship between diabetes and vaccination.

CONCLUSION

There is a complex relationship between vaccination and diabetes with a bidirectional effect. Vaccination may contribute to the risk of worsening blood glucose in diabetic patients and diabetic patients may have a lower antibody response after vaccination than the general population.

Keywords: COVID-19, Vaccination, Diabetes mellitus, Antibody, Blood glucose, Immune response

Core Tip: Coronavirus disease 2019 (COVID-19) is one of the current global public health threats and vaccination is the most effective tool to reduce the spread and decrease the severity of COVID-19. Diabetes is one of the important chronic diseases threatening human health and is a common comorbidity of COVID-19. There are limited and conflicting data on the interrelationship between diabetes and COVID-19 vaccination. Vaccination may be at risk of worsening glycemia in diabetic patients, and diabetic patients may have a lower immune response after vaccination than the general population, and there is a bidirectional relationship between vaccination and diabetes.