COVID-19 Vaccination and Diabetes Mellitus: How Much Has It Made a Difference to Outcomes Following Confirmed COVID-19 Infection?

Adrian H Heald; David A Jenkins; Richard Williams; Rajshekhar N Mudaliar; Asma Naseem; Kelly A Bowden Davies; J Martin Gibson; Yonghong Peng; William Ollier

doi:10.1007/s13300-022-01338-5

COVID-19 Vaccination and Diabetes Mellitus: How Much Has It Made a Difference to Outcomes Following Confirmed COVID-19 Infection?

Diabetes Ther. 2023 Jan;14(1):193-204. doi: 10.1007/s13300-022-01338-5. Epub 2022 Dec 7.

Authors

Adrian H Heald^{1

2}, David A Jenkins^{3

4}, Richard Williams^{3

4

5}, Rajshekhar N Mudaliar⁶, Asma Naseem⁶, Kelly A Bowden Davies⁷, J Martin Gibson^{8

6}, Yonghong Peng⁹, William Ollier⁹

Affiliations

¹ The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK. adrian.heald@manchester.ac.uk.
² Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK. adrian.heald@manchester.ac.uk.
³ Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁴ NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.
⁵ NIHR Applied Research Collaboration Greater Manchester, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁶ Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
⁷ Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK.
⁸ The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
⁹ Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.

Abstract

Introduction: Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus (COVID-19), its successive variants and the associated pandemic caused. We have previously shown that for people living with type 2 diabetes (T2DM), the risk of being admitted to hospital or dying following a COVID-19 infection progressively decreased through the first months of 2021. In this subsequent analysis we have examined how the UK COVID-19 vaccination programme impacted differentially on COVID-19 outcomes in people with T1DM or T2DM compared to appropriate controls.

Methods: T1DM and T2DM affected individuals were compared with their matched controls on 3:1 ratio basis. A 28-day hospital admission or mortality was used as the binary outcome variable with diabetes status and vaccination for COVID-19 as the main exposure variables.

Results: A higher proportion of T1DM individuals vs their controls was found to be vaccinated at the point of their first recorded positive COVID-19 test when compared to T2DM individuals vs their controls. Regarding the 28-day hospital admission rate, there was a greater and increasing protective effect of subsequent vaccination dosage (one, two or three) in mitigating the effects of COVID-19 infection versus no vaccination in T1DM than in T2DM individuals when compared with matched controls. Similar effects were observed in T2DM for death. Across both diabetes and non-diabetes individuals, those at greater socio-economic disadvantage were more likely to test positive for COVID-19 in the early phase of the pandemic. For T2DM individuals socio-economic disadvantage was associated with a greater likelihood of hospital admission and death, independent of vaccination status. Age and male sex were also independently associated with 28-day hospital admission in T2DM and to 28-day mortality, independent of vaccination status. African ethnicity was also an additional factor for hospital admission in people with T2DM.

Conclusion: A beneficial effect of COVID-19 vaccination was seen in mitigating the harmful effects of COVID-19 infection; this was manifest in reduced hospital admission rate in T1DM individuals with a lesser effect in T2DM when compared with matched controls, regarding both hospital admission and mortality. Socio-economic disadvantage influenced likelihood of COVID-19 confirmed infection and the likelihood of hospital admission/death independent of the number of vaccinations given in T2DM.

Keywords: COVID-19; Outcome; SARS-CoV-2; T1DM; T2DM; Vaccination.