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Marfella R, Sardu C, D'Onofrio N, Prattichizzo F, Scisciola L, Messina V, La Grotta R, Balestrieri ML, Maggi P, Napoli C, Ceriello A, Paolisso G. Glycaemic control is associated with SARS-CoV-2 breakthrough infections in vaccinated patients with type 2 diabetes. Nat Commun 2022; 13:2318. [PMID: 35484164 PMCID: PMC9051134 DOI: 10.1038/s41467-022-30068-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with type 2 diabetes (T2D) are characterized by blunted immune responses, which are affected by glycaemic control. Whether glycaemic control influences the response to COVID-19 vaccines and the incidence of SARS-CoV-2 breakthrough infections is unknown. Here we show that poor glycaemic control, assessed as mean HbA1c in the post-vaccination period, is associated with lower immune responses and an increased incidence of SARS-CoV-2 breakthrough infections in T2D patients vaccinated with mRNA-BNT162b2. We report data from a prospective observational study enroling healthcare and educator workers with T2D receiving the mRNA-BNT162b2 vaccine in Campania (Italy) and followed for one year (5 visits, follow-up 346 ± 49 days) after one full vaccination cycle. Considering the 494 subjects completing the study, patients with good glycaemic control (HbA1c one-year mean < 7%) show a higher virus-neutralizing antibody capacity and a better CD4 + T/cytokine response, compared with those with poor control (HbA1c one-year mean ≥ 7%). The one-year mean of HbA1c is linearly associated with the incidence of breakthrough infections (Beta = 0.068; 95% confidence interval [CI], 0.032-0.103; p < 0.001). The comparison of patients with poor and good glycaemic control through Cox regression also show an increased risk for patients with poor control (adjusted hazard ratio [HR], 0.261; 95% CI, 0.097-0.700; p = 0.008). Among other factors, only smoking (HR = 0.290, CI 0.146-0.576 for non-smokers; p < 0.001) and sex (HR = 0.105, CI 0.035-0.317 for females; p < 0.001) are significantly associated with the incidence of breakthrough infections. In this study, Marfella et al. show that patients with diabetes and poor glycaemic control have a blunted response to COVID-19 vaccine and are more prone to develop breakthrough infections, with further analysis suggesting smoking and male sex as potential risk factors to get COVID-19 despite vaccination.
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Affiliation(s)
- Raffaele Marfella
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy. .,Mediterranea Cardiocentro, 80122, Naples, Italy.
| | - Celestino Sardu
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - Nunzia D'Onofrio
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | | | - Lucia Scisciola
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | | | | | - Maria Luisa Balestrieri
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - Paolo Maggi
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - Claudio Napoli
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | | | - Giuseppe Paolisso
- Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy.,Mediterranea Cardiocentro, 80122, Naples, Italy
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