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Analysis of continuous glucose tracking data in people with Type 1 Diabetes (T1DM) after Covid-19 Vaccination reveals unexpected link between immune and metabolic response, augmented by adjunctive oral medication
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  • Adrian Heald,
  • Rustam Rea,
  • Linda Horne,
  • Ann Metters,
  • Tom Steele,
  • Kathryn Leivesley,
  • Martin Whyte,
  • Mike Stedman,
  • Bill Ollier
Adrian Heald
Salford Royal Hospitals NHS Trust
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Rustam Rea
Oxford Centre for Diabetes Endocrinology and Metabolism
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Linda Horne
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Ann Metters
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Tom Steele
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Kathryn Leivesley
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Martin Whyte
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Mike Stedman
Res Consortium
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Bill Ollier
University of Manchester
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Abstract

Introduction The COVID-19 vaccination programme is under way. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before and after vaccination. Methods We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage(%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). Results There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). Conclusion In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.

Peer review status:ACCEPTED

29 May 2021Submitted to International Journal of Clinical Practice
31 May 2021Submission Checks Completed
31 May 2021Assigned to Editor
08 Jun 2021Reviewer(s) Assigned
01 Jul 2021Review(s) Completed, Editorial Evaluation Pending
01 Jul 2021Editorial Decision: Revise Minor
07 Jul 20211st Revision Received
10 Jul 2021Submission Checks Completed
10 Jul 2021Assigned to Editor
10 Jul 2021Review(s) Completed, Editorial Evaluation Pending
17 Jul 2021Editorial Decision: Accept