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Alsudais AS, Alkanani RS, Fathi AB, Almuntashiri SS, Jamjoom JN, Alzhrani MA, Althubaiti A, Radi S. Autoimmune diabetes mellitus after COVID-19 vaccination in adult population: a systematic review of case reports. BMC Endocr Disord 2023; 23:164. [PMID: 37542216 PMCID: PMC10403898 DOI: 10.1186/s12902-023-01424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Autoimmune/type 1 diabetes mellitus (T1DM) is a recently described rare occurrence following the administration of adjuvants such as coronavirus disease 2019 (COVID-19) vaccines. This systematic review aimed to review all available literature on the potential association between COVID-19 vaccines and T1DM. METHODS The Directory of Open Access Journals, MEDLINE, Google Scholar, and Scopus were systematically searched for all published studies from inception to July 2022. Articles reporting T1DM development within 8 weeks of administration of COVID-19 vaccine were included. Two reviewers independently performed the risk of bias assessment following the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. RESULTS Eight eligible studies were retrieved, comprising 12 patients diagnosed with T1DM after being vaccinated with a COVID-19 vaccine. Six patients (50%) reported T1DM after receiving the second dose. Five patients (41.7%) presented with diabetic ketoacidosis, of which four presented within the first eight days after vaccination. Five patients (41.7%) had genetic susceptibility, with RNA binding motif protein 45 (RBM45/DRB1) and major histocompatibility complex, class II, DQ beta 1 (HLA-DQB1) mutations being prominent. INTERPRETATION In this review, we have shown a small number of new-onset diabetes cases coincidently occurring soon after the COVID-19 vaccine, especially in those with genetic susceptibility. Despite being older, these patients had a similar phenotype to T1DM. While there might be a causal relationship between COVID-19 vaccines and T1DM development, this should not influence decisions regarding vaccination since the overall benefit outweighs the risk. Further larger prospective trials are needed to assess causal relationship and to clarify the potential roles of COVID-19 vaccine-derived antigens in autoimmune disease development. PROTOCOL REGISTRATION PROSPERO-CRD42022342093.
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Affiliation(s)
- Ali S Alsudais
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Raghad S Alkanani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Abdulaziz B Fathi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Saleh S Almuntashiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Jafar N Jamjoom
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Mustafa A Alzhrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Alaa Althubaiti
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Suhaib Radi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Department of Internal Medicine, Division of Endocrinology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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Nolasco-Rosales GA, Ramírez-González D, Rodríguez-Sánchez E, Ávila-Fernandez Á, Villar-Juarez GE, González-Castro TB, Tovilla-Zárate CA, Guzmán-Priego CG, Genis-Mendoza AD, Ble-Castillo JL, Marín-Medina A, Juárez-Rojop IE. Identification and phenotypic characterization of patients with LADA in a population of southeast Mexico. Sci Rep 2023; 13:7029. [PMID: 37120620 PMCID: PMC10148806 DOI: 10.1038/s41598-023-34171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/25/2023] [Indexed: 05/01/2023] Open
Abstract
Latent autoimmune diabetes in adults (LADA) has clinical and metabolic features of type 1 and type 2 diabetes. LADA does not have specific features for its diagnosis apart from autoantibody detection; however, these tests are not affordable in clinical settings. In this cross-sectional study, we analyzed clinical criteria, metabolic control, pharmacological treatment, and diabetic complications in two groups of patients with diabetes -LADA and T2D- in order to identify specific characteristic of these clinical entities. Finally, we evaluated if the estimated glucose disposal rate (eGDR) and age at diagnosis of diabetes could be used as a diagnostic criterion for LADA. Demographic, biochemical, clinical and treatment were measured in 377 individuals with diabetes. The diagnostics of LADA were determined using Glutamic acid decarboxylase autoantibodies levels. Chi-square test or t-Student test were used to establish differences between groups. To identify factors associated with LADA, a logistic regression analysis was used. Finally, a ROC curve was plotted to assess the possible variables as diagnostic criteria for LADA. The 377 patients with diabetes were separated into 59 patients with LADA and 318 patients with T2D. Patients with LADA showed lower fasting glucose values, fewer diabetic complications, younger age at diagnosis of diabetes, higher insulin use, and higher eGDR in comparison to patients with T2D. Both groups had a mean BMI classified as overweight. The ROC evaluated the sensitivity and specificity, this analysis indicated that an age younger than 40.5 years and an eGDR value higher than 9.75 mg/kg/min correlated better with LADA. These parameters could be useful to identify patients suspected to have LADA at the first level of medical care in the population of southeastern Mexico and refer them to a second level of care.
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Affiliation(s)
| | - Dania Ramírez-González
- División Académica de Ciencias de la Salud, Universidad Juarez Autónoma de Tabasco, Villahermosa, Tabasco, México
- Hospital Juárez de México, Mexico City, México
| | - Ester Rodríguez-Sánchez
- Hospital Regional de Alta Especialidad "Gustavo A. Rovirosa Pérez", Villahermosa, Tabasco, México
| | - Ángela Ávila-Fernandez
- División Académica de Ciencias de la Salud, Universidad Juarez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | | | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juarez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juarez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | | | - Alma Delia Genis-Mendoza
- Departamento de Genética Psiquiátrica, Instituto Nacional de Medicina Genómica, Mexico City, México
| | - Jorge Luis Ble-Castillo
- División Académica de Ciencias de la Salud, Universidad Juarez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | | | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juarez Autónoma de Tabasco, Villahermosa, Tabasco, México.
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Sjöholm Å. Atypical diabetes: a diagnostic challenge. BMJ Open Diabetes Res Care 2020; 8:8/1/e001470. [PMID: 32771985 PMCID: PMC7418657 DOI: 10.1136/bmjdrc-2020-001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 02/03/2023] Open
Abstract
In medical school, we learned how to classify diabetes according to different clinical characteristics. However, at the dawn of the precision medicine era, it is clear that today's clinical reality does not always align well with textbook teachings. The terms juvenile versus elderly-onset diabetes, as well as insulin-dependent versus non-insulin-dependent diabetes, have become obsolete. Contrary to what is often taught severe ketoacidosis may occur in type 2 diabetes. Patients may also suffer from two or more forms of diabetes simultaneously or consecutively. Five authentic cases of diabetes with uncommon characteristics that pose diagnostic challenges are presented here.
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Affiliation(s)
- Åke Sjöholm
- Department of Internal Medicine, Region Gävleborg, Gavle, Sweden
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