J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 13, Number 4, November 2023, pages 144-152

Acute Effect of COVID-19 Vaccination on Glycemic Profile in Patients With Type 1 Diabetes Mellitus

Figure 1. (a) Glycemic profile (time in range, time above range and time below range) changes in response to COVID-19 vaccination. (b) Glycemic variability changes in response to COVID-19 vaccination. COVID-19: coronavirus disease 2019; TAR: time above range; TBR: time below range; TIR: time in range.

**Table 1.** Demographic and Clinical Characteristics of the Study Population
Parameters	Mean ± SD or N (%)
BMI: body mass index; COVID-19: coronavirus disease 2019; HbA1c: glycated hemoglobin; SD: standard deviation.
Total number of patients	44
Age (years)	28.89 ± 10.28
Sex
Male	19 (26.40%)
Female	53 (73.6%)
Duration of diabetes (years)	11.63 ± 8.68
BMI (kg/m²)	26.88 ± 6.4
Total number of COVID-19 vaccine	72
Vaccine doses
First dose	22 (30.6%)
Second dose	22 (30.6%)
Third dose	28 (38.9%)
Vaccine types
AstraZeneca	3 (4.2%)
Moderna	7 (9.7%)
Pfizer	62 (86.1%)
HbA1c before vaccine (%)	9.02 ± 1.92
Fasting blood glucose before vaccine (mmol/L)	11.79 ± 5.17
Medication before vaccine
Metformin	10 (13.9%)
Semaglutide	2 (2.8%)
Aspart	72 (100%)
Glargine 100	66 (91.7%)
Glargine 300	2 (2.8%)
Degludec	2 (2.8%)
Detemir	2 (2.8%)
Insulin doses (units)
Aspart	29.1 ± 13.82
Glargine100	21.74 ± 13.82
Glargine 300	16.5 ± 0.71
Degludec	39 ± 1.41
Detemir	17

Table 1. Demographic and Clinical Characteristics of the Study Population

Parameters

Mean ± SD or N (%)

BMI: body mass index; COVID-19: coronavirus disease 2019; HbA1c: glycated hemoglobin; SD: standard deviation.

Total number of patients

Age (years)

28.89 ± 10.28

Sex

Male

19 (26.40%)

Female

53 (73.6%)

Duration of diabetes (years)

11.63 ± 8.68

BMI (kg/m²)

26.88 ± 6.4

Total number of COVID-19 vaccine

Vaccine doses

First dose

22 (30.6%)

Second dose

22 (30.6%)

Third dose

28 (38.9%)

Vaccine types

AstraZeneca

3 (4.2%)

Moderna

7 (9.7%)

Pfizer

62 (86.1%)

HbA1c before vaccine (%)

9.02 ± 1.92

Fasting blood glucose before vaccine (mmol/L)

11.79 ± 5.17

Medication before vaccine

Metformin

10 (13.9%)

Semaglutide

2 (2.8%)

Aspart

72 (100%)

Glargine 100

66 (91.7%)

Glargine 300

2 (2.8%)

Degludec

2 (2.8%)

Detemir

2 (2.8%)

Insulin doses (units)

Aspart

29.1 ± 13.82

Glargine100

21.74 ± 13.82

Glargine 300

16.5 ± 0.71

Degludec

39 ± 1.41

Detemir

**Table 2.** Results of Statistical Subgroup Analysis (Wilcoxon Signed Rank Test) of Changes in Glycemic Parameters After COVID-19 Vaccination
Group	Subgroup	Glycemic parameter pairs
^aP ≤ 0.05. BMI: body mass index; DM: diabetes mellitus; GV: glycemic variability; HbA1c: glycated hemoglobin; TAR: time above range; TBR: time below range; TIR: time in range.
Age	≤ 28 years old	-0.34	0.734	-0.33	0.743	-0.57	0.566	-0.75	0.45	-2.75	0.006^a	-2.14	0.032^a	-0.59	0.557	-0.23	0.817
	> 28 years old	-2.93	0.003^a	-2.17	0.03^a	-2.02	0.043^a	-1.55	0.122	-1.02	0.309	-0.69	0.491	-0.51	0.611	-0.28	0.779
DM duration	≤ 10.5 years	-0.02	0.98	-0.25	0.806	-0.32	0.752	-0.23	0.817	-2.08	0.037^a	-0.65	0.514	-1.4	0.161	-0.13	0.898
	> 10.5 years	-2.68	0.007^a	-2.5	0.012^a	-2.27	0.023^a	-2.12	0.034^a	-0.14	0.888	-0.66	0.507	-0.35	0.729	-0.49	0.626
BMI before	≤ 27.4 kg/m²	-1.1	0.27	-0.99	0.323	-1.51	0.13	-0.94	0.348	-1.72	0.086	-0.2	0.844	-0.49	0.622	-0.06	0.948
	> 27.4 kg/m²	-1.43	0.154	-1.3	0.194	-1.12	0.264	-0.9	0.367	-0.16	0.871	-0.32	0.747	-0.6	0.546	-0.26	0.795
HbA1c before	≤ 8.55%	-2.24	0.025^a	-2.93	0.003^a	-2.33	0.02^a	-2.61	0.009^a	-0.65	0.515	-0.72	0.475	-0.23	0.819	0	1
	> 8.55%	-1.47	0.142	-0.31	0.76	-1.37	0.17	-0.01	0.989	-0.88	0.377	0	1	-1.44	0.149	0	1
Gender	Male	-1.04	0.3	-1.57	0.116	-0.57	0.569	-1.61	0.107	-0.88	0.379	-1.24	0.214	-0.47	0.642	-1.01	0.314
	Female	-1.15	0.25	-0.86	0.388	-1.49	0.135	-0.7	0.486	-0.98	0.328	-0.38	0.701	-0.58	0.561	-0.34	0.736
Vaccine type	AstraZeneca	-1.6	0.109	-1.6	0.109	-1.34	0.18	-0.82	0.414	-1.34	0.18	-1	0.317	-1.07	0.285	0	1
	Moderna	-0.42	0.671	-0.17	0.866	-0.08	0.933	-0.1	0.917	-1.83	0.068	-1.19	0.236	-1.01	0.31	-1.15	0.249
	Pfizer	-1.48	0.138	-1.52	0.128	-1.49	0.136	-1.49	0.137	-0.86	0.388	-0.97	0.334	-0.27	0.79	-0.17	0.863
Vaccine dose	First dose	-0.43	0.664	-0.43	0.667	-0.07	0.94	-0.77	0.444	-1.9	0.058	-1.7	0.09	-0.1	0.917	-0.02	0.986
	Second dose	-1.23	0.219	-1.25	0.211	-1.14	0.254	-1.27	0.204	-0.86	0.388	-0.97	0.333	-0.13	0.896	-0.02	0.986
	Third dose	-1.73	0.084	-0.97	0.333	-1.7	0.089	-0.83	0.404	-0.07	0.94	-0.2	0.841	-1.08	0.28	-0.06	0.955

Table 2. Results of Statistical Subgroup Analysis (Wilcoxon Signed Rank Test) of Changes in Glycemic Parameters After COVID-19 Vaccination

Group

Subgroup

Glycemic parameter pairs

TIR

TAR

TBR

1 week before vs. 1 week after

2 weeks before vs. 2 weeks after

1 week before vs. 1 week after

2 weeks before vs. 2 weeks after

1 week before vs. 1 week after

2 weeks before vs. 2 weeks after

1 week before vs. 1 week after

2 weeks before vs. 2 weeks after

P value

^aP ≤ 0.05. BMI: body mass index; DM: diabetes mellitus; GV: glycemic variability; HbA1c: glycated hemoglobin; TAR: time above range; TBR: time below range; TIR: time in range.

Age

≤ 28 years old

-0.34

0.734

-0.33

0.743

-0.57

0.566

-0.75

0.45

-2.75

0.006^a

-2.14

0.032^a

-0.59

0.557

-0.23

0.817

> 28 years old

-2.93

0.003^a

-2.17

0.03^a

-2.02

0.043^a

-1.55

0.122

-1.02

0.309

-0.69

0.491

-0.51

0.611

-0.28

0.779

DM duration

≤ 10.5 years

-0.02

0.98

-0.25

0.806

-0.32

0.752

-0.23

0.817

-2.08

0.037^a

-0.65

0.514

-1.4

0.161

-0.13

0.898

> 10.5 years

-2.68

0.007^a

-2.5

0.012^a

-2.27

0.023^a

-2.12

0.034^a

-0.14

0.888

-0.66

0.507

-0.35

0.729

-0.49

0.626

BMI before

≤ 27.4 kg/m²

-1.1

0.27

-0.99

0.323

-1.51

0.13

-0.94

0.348

-1.72

0.086

-0.2

0.844

-0.49

0.622

-0.06

0.948

> 27.4 kg/m²

-1.43

0.154

-1.3

0.194

-1.12

0.264

-0.9

0.367

-0.16

0.871

-0.32

0.747

-0.6

0.546

-0.26

0.795

HbA1c before

≤ 8.55%

-2.24

0.025^a

-2.93

0.003^a

-2.33

0.02^a

-2.61

0.009^a

-0.65

0.515

-0.72

0.475

-0.23

0.819

> 8.55%

-1.47

0.142

-0.31

0.76

-1.37

0.17

-0.01

0.989

-0.88

0.377

-1.44

0.149

Gender

Male

-1.04

0.3

-1.57

0.116

-0.57

0.569

-1.61

0.107

-0.88

0.379

-1.24

0.214

-0.47

0.642

-1.01

0.314

Female

-1.15

0.25

-0.86

0.388

-1.49

0.135

-0.7

0.486

-0.98

0.328

-0.38

0.701

-0.58

0.561

-0.34

0.736

Vaccine type

AstraZeneca

-1.6

0.109

-1.6

0.109

-1.34

0.18

-0.82

0.414

-1.34

0.18

-1

0.317

-1.07

0.285

Moderna

-0.42

0.671

-0.17

0.866

-0.08

0.933

-0.1

0.917

-1.83

0.068

-1.19

0.236

-1.01

0.31

-1.15

0.249

Pfizer

-1.48

0.138

-1.52

0.128

-1.49

0.136

-1.49

0.137

-0.86

0.388

-0.97

0.334

-0.27

0.79

-0.17

0.863

Vaccine dose

First dose

-0.43

0.664

-0.43

0.667

-0.07

0.94

-0.77

0.444

-1.9

0.058

-1.7

0.09

-0.1

0.917

-0.02

0.986

Second dose

-1.23

0.219

-1.25

0.211

-1.14

0.254

-1.27

0.204

-0.86

0.388

-0.97

0.333

-0.13

0.896

-0.02

0.986

Third dose

-1.73

0.084

-0.97

0.333

-1.7

0.089

-0.83

0.404

-0.07

0.94

-0.2

0.841

-1.08

0.28

-0.06

0.955

**Table 3.** Results of Multiple Regression Analysis for Variables Predicting Changes in Glycemic Parameters After COVID-19 Vaccination
Model	Unstandardized coefficients	Standardized coefficients
^aP ≤ 0.05. BMI: body mass index; DM: diabetes mellitus; GV: glycemic variability; HbA1c: glycated hemoglobin; TAR: time above range; TBR: time below range; TIR: time in range.
TIR 1 week difference
Age	0	0.16	-0.01	-0.03	0.975
DM duration	-0.03	0.23	-0.02	-0.11	0.914
HbA1c before vaccine	-0.56	0.77	-0.11	-0.73	0.469
BMI before vaccine	-0.06	0.24	-0.04	-0.25	0.805
Gender	1.2	4.04	0.05	0.3	0.768
Vaccine dose	-3	1.92	-0.25	-1.56	0.126
Vaccine type	2.37	2.91	0.13	0.82	0.419
TIR 2 weeks difference
Age	-0.03	0.13	-0.04	-0.25	0.801
DM duration	-0.19	0.19	-0.17	-1	0.322
HbA1c before vaccine	1.43	0.63	0.33	2.27	0.029^a
BMI before vaccine	0.12	0.2	0.09	0.59	0.561
Gender	4.2	3.3	0.21	1.27	0.21
Vaccine dose	0.16	1.57	0.02	0.1	0.92
Vaccine type	0.07	2.37	0	0.03	0.977
TAR 1 week difference
Age	-0.12	0.16	-0.13	-0.74	0.461
DM duration	0.1	0.24	0.07	0.4	0.688
HbA1c before vaccine	-0.09	0.79	-0.02	-0.11	0.909
BMI before vaccine	0.01	0.25	0.01	0.04	0.965
Gender	0.48	4.14	0.02	0.12	0.908
Vaccine dose	1.88	1.97	0.15	0.95	0.347
TAR 2 weeks difference
Age	-0.09	0.13	-0.1	-0.65	0.522
DM duration	0.27	0.2	0.21	1.34	0.186
HbA1c before vaccine	-1.92	0.66	-0.4	-2.93	0.005^a
BMI before vaccine	-0.16	0.21	-0.11	-0.78	0.439
Gender	-6.39	3.44	-0.3	-1.86	0.07
Vaccine dose	-0.74	1.64	-0.07	-0.45	0.654
Vaccine type	0.69	2.47	0.04	0.28	0.782
TBR 1 week difference
Age	-0.12	0.16	-0.13	-0.74	0.461
DM duration	0.1	0.24	0.07	0.4	0.688
HbA1c before vaccine	-0.09	0.79	-0.02	-0.11	0.909
BMI before vaccine	0.01	0.25	0.01	0.04	0.965
Gender	0.48	4.14	0.02	0.12	0.908
Vaccine dose	1.88	1.97	0.15	0.95	0.347
Vaccine type	-3.16	2.98	-0.17	-1.06	0.295
TBR 2 weeks difference
Age	0.17	0.09	0.3	1.81	0.077
DM duration	-0.08	0.14	-0.11	-0.62	0.542
HbA1c before vaccine	0.55	0.45	0.18	1.23	0.227
BMI before vaccine	-0.09	0.14	-0.1	-0.64	0.527
Gender	1.82	2.36	0.13	0.77	0.445
Vaccine dose	-0.23	1.12	-0.03	-0.2	0.839
Vaccine type	-0.83	1.7	-0.08	-0.49	0.625
GV 1 week difference
Age	-0.12	0.11	-0.17	-1.02	0.313
DM duration	-0.01	0.17	-0.01	-0.03	0.975
HbA1c before vaccine	-0.54	0.56	-0.15	-0.97	0.337
BMI before vaccine	-0.11	0.17	-0.1	-0.62	0.538
Gender	-2.33	2.92	-0.14	-0.8	0.43
Vaccine dose	-1.01	1.39	-0.11	-0.73	0.472
Vaccine type	1.77	2.1	0.13	0.84	0.405
GV 2 weeks difference
Age	0	0.09	0	-0.03	0.979
DM duration	-0.08	0.13	-0.11	-0.64	0.525
HbA1c before vaccine	0.66	0.43	0.23	1.55	0.128
BMI before vaccine	-0.06	0.13	-0.07	-0.43	0.668
Gender	2.58	2.23	0.2	1.16	0.254
Vaccine dose	0.08	1.06	0.01	0.08	0.94
Vaccine type	0.82	1.61	0.08	0.51	0.614

Table 3. Results of Multiple Regression Analysis for Variables Predicting Changes in Glycemic Parameters After COVID-19 Vaccination

Model

Unstandardized coefficients

Standardized coefficients

Std. error

Beta

Sig.

^aP ≤ 0.05. BMI: body mass index; DM: diabetes mellitus; GV: glycemic variability; HbA1c: glycated hemoglobin; TAR: time above range; TBR: time below range; TIR: time in range.

TIR 1 week difference

Age

0.16

-0.01

-0.03

0.975

DM duration

-0.03

0.23

-0.02

-0.11

0.914

HbA1c before vaccine

-0.56

0.77

-0.11

-0.73

0.469

BMI before vaccine

-0.06

0.24

-0.04

-0.25

0.805

Gender

1.2

4.04

0.05

0.3

0.768

Vaccine dose

-3

1.92

-0.25

-1.56

0.126

Vaccine type

2.37

2.91

0.13

0.82

0.419

TIR 2 weeks difference

Age

-0.03

0.13

-0.04

-0.25

0.801

DM duration

-0.19

0.19

-0.17

-1

0.322

HbA1c before vaccine

1.43

0.63

0.33

2.27

0.029^a

BMI before vaccine

0.12

0.2

0.09

0.59

0.561

Gender

4.2

3.3

0.21

1.27

0.21

Vaccine dose

0.16

1.57

0.02

0.1

0.92

Vaccine type

0.07

2.37

0.03

0.977

TAR 1 week difference

Age

-0.12

0.16

-0.13

-0.74

0.461

DM duration

0.1

0.24

0.07

0.4

0.688

HbA1c before vaccine

-0.09

0.79

-0.02

-0.11

0.909

BMI before vaccine

0.01

0.25

0.01

0.04

0.965

Gender

0.48

4.14

0.02

0.12

0.908

Vaccine dose

1.88

1.97

0.15

0.95

0.347

TAR 2 weeks difference

Age

-0.09

0.13

-0.1

-0.65

0.522

DM duration

0.27

0.2

0.21

1.34

0.186

HbA1c before vaccine

-1.92

0.66

-0.4

-2.93

0.005^a

BMI before vaccine

-0.16

0.21

-0.11

-0.78

0.439

Gender

-6.39

3.44

-0.3

-1.86

0.07

Vaccine dose

-0.74

1.64

-0.07

-0.45

0.654

Vaccine type

0.69

2.47

0.04

0.28

0.782

TBR 1 week difference

Age

-0.12

0.16

-0.13

-0.74

0.461

DM duration

0.1

0.24

0.07

0.4

0.688

HbA1c before vaccine

-0.09

0.79

-0.02

-0.11

0.909

BMI before vaccine

0.01

0.25

0.01

0.04

0.965

Gender

0.48

4.14

0.02

0.12

0.908

Vaccine dose

1.88

1.97

0.15

0.95

0.347

Vaccine type

-3.16

2.98

-0.17

-1.06

0.295

TBR 2 weeks difference

Age

0.17

0.09

0.3

1.81

0.077

DM duration

-0.08

0.14

-0.11

-0.62

0.542

HbA1c before vaccine

0.55

0.45

0.18

1.23

0.227

BMI before vaccine

-0.09

0.14

-0.1

-0.64

0.527

Gender

1.82

2.36

0.13

0.77

0.445

Vaccine dose

-0.23

1.12

-0.03

-0.2

0.839

Vaccine type

-0.83

1.7

-0.08

-0.49

0.625

GV 1 week difference

Age

-0.12

0.11

-0.17

-1.02

0.313

DM duration

-0.01

0.17

-0.01

-0.03

0.975

HbA1c before vaccine

-0.54

0.56

-0.15

-0.97

0.337

BMI before vaccine

-0.11

0.17

-0.1

-0.62

0.538

Gender

-2.33

2.92

-0.14

-0.8

0.43

Vaccine dose

-1.01

1.39

-0.11

-0.73

0.472

Vaccine type

1.77

2.1

0.13

0.84

0.405

GV 2 weeks difference

Age

0.09

-0.03

0.979

DM duration

-0.08

0.13

-0.11

-0.64

0.525

HbA1c before vaccine

0.66

0.43

0.23

1.55

0.128

BMI before vaccine

-0.06

0.13

-0.07

-0.43

0.668

Gender

2.58

2.23

0.2

1.16

0.254

Vaccine dose

0.08

1.06

0.01

0.08

0.94

Vaccine type

0.82

1.61

0.08

0.51

0.614