Can people with diabetes be vaccinated?
In Hong Kong, diabetes is a major chronic disease affecting 700,000 people, i.e. 1 in 10 people have diabetes. According to the International Diabetes Federation, the number of people with diabetes in Hong Kong will surge to 920,000 (or 13% of the population) by 2030. Can people with diabetes be vaccinated?
Professor Juliana Chan, Chair Professor of Medicine and Therapeutics and Founding Director of the Hong Kong Institute of Diabetes and Obesity at CUHK and Dr. Andrea Luk, Associate Professor, Division of Endocrinology and Diabetes, Department of Medicine and Therapeutics at CUHK Medicine provide six key points for us.
- People with diabetes are at high risk for developing severe COVID-19 related complications including death.
- Unless they had severe allergic reactions or nerve damage to vaccines in the past, all people with type 1 or type 2 diabetes should consider being vaccinated to protect themselves.
- All approved vaccines have been evaluated under closely monitored condition with comparison against placebo with no evidence of these vaccines increasing the risk of common diseases such as heart disease or stroke.
- Experts recommend patients with diabetes to receive annual flu jabs to reduce risk of severe pneumonia. If they have been following this, then there is no reason why they should not take COVID-19 vaccines.
- COVID-19 vaccines by Sinovac use the same technology as traditional flu vaccines. People who have taken flu vaccines before with no major side effects may consider choosing this. On the other hand, BioNTech vaccines have a wealth of data showing its safety and effectiveness in people in different ages and clinical conditions.
- The key question is to get vaccinated but not which type of vaccines. We hope everyone will act now and get vaccinated to save lives and protect our healthcare system.
Q: Are people with diabetes more likely to get COVID-19 infection?
A: In July last year, the School of Biomedicine at CUHK Medicine published a report showing that diabetes may increase the risk of getting COVID-19 infection. People with diabetes have increased expression of the ACE2 receptor (also known as “angiotensin converting enzyme”), which is a key receptor for the Coronavirus to invade the human body. The higher the expression of this receptor, the higher the chance of infection, and the more severe the patient’s condition can become after infection.1
Q: If a patient with diabetes has COVID-19, is he/she more likely to develop serious complications or die?
A: Patients with diabetes and COVID-19 have 2-3 fold higher risk of developing serious complications including admission to intensive care unit, assisted ventilation and/or death than those without diabetes. Other factors for serious or deadly COVID-19 include old age, male sex and obesity. These high-risk groups should be vaccinated to avoid getting severe COVID-19.
In people with poorly controlled diabetes, their internal organs are exposed to a high-sugar environment for a long period of time. This unfavorable condition can reduce their immunity to ward off infections by bacteria and virus and accelerate the aging process by as much as 10 years than their peers without diabetes. As with most infections, the body needs more energy to fight against the Coronavirus. In people with diabetes, this can further increase the blood glucose level and make them more prone to develop other infections with further damage to their blood vessels, heart and kidneys.
According to a recent report by the University Hospital Nantes in France2, 1 in 5 hospitalized patients with diabetes and COVID-19 died within 28 days of admission. In a nationwide study conducted in the United Kingdom, amongst those who died from COVID-19, 1 in 3 had diabetes. People with diabetes and unstable glycemic control or underlying cardiovascular and kidney disease were also more prone to develop serious complications due to COVID-193.
In fact, a recent report published by the CUHK Diabetes Research Team4 showed that people with diabetes were more likely to be hospitalized due to influenza and pneumonia. More importantly, people have 2 to 4 times increased risk of developing a heart attack or stroke after being hospitalization due to pneumonia5. This is exactly the reason why experts strongly recommend patients with diabetes receive pneumonia and influenza vaccination to reduce the risk of serious complications.
Q: Can people with diabetes get the COVID-19 vaccines? Which vaccine should they choose?
A: Most countries such as UK and USA consider patients with diabetes as a priority group to receive vaccines in order to reduce their chances of developing severe COVID-19. All people with type 1 or type 2 diabetes should consider being vaccinated, unless they had a history of vaccine-related severe allergic reactions or nerve damage or other medical conditions that make it unsafe for them to receive vaccination. Please visit the website of the Hong Kong Department of Health for more details. (https://www.covidvaccine.gov.hk/en/faq)
Experts recommend patients with diabetes to receive annual flu jabs to reduce risk of severe pneumonia. If they have been following this, then there is no reason why they should not take COVID-19 vaccines. Based on clinical trials and real-world evidence, both BioNtech and Sinovac vaccines have been proven to be safe and effective and approved by the World Health Organization. Globally, over 2 billion people, including patients with diabetes and chronic diseases, have been vaccinated and the rate of severe COVID 19 infections have fallen markedly in countries with high vaccination rates of 60-70%, such as Israel, UK and USA.
Traditional flu vaccines use the same technology as vaccine produced by Sinovac i.e. inactivated vaccines. People who have received flu vaccines in the past with no allergic reactions may consider using vaccines produced by Sinovac. On the other hand, there is a wealth of published data relating to vaccine produced by BioNtech which covered many age groups and clinical conditions with proven efficacy and safety. The key question is to get vaccinated but not which type of vaccines.
By 16 June 2021, the total number of COVID-19 vaccination doses administered in Hong Kong approached 3,041,700. The Department of Health had received about 3,000 reports of abnormal events, i.e. 0.14% or 1 in 1000 people who received vaccination. Most of these events were not serious. For serious events such as stroke and heart disease, after review by experts, they were not considered to be caused by the vaccines.
It is important to point out that in the assessment of a causal relationship between a drug or vaccine and serious events, apart from the timing, we have to consider 1) whether there are other pre-existing conditions that may explain these adverse events and 2) whether there are mechanisms that can associate the vaccines with the adverse events. The safety and efficacy of these vaccines approved by the World Health Organization have been closely monitored and compared with placebo in clinical trials with no evidence of increased incidence of common diseases such as heart disease or stroke. Only by having more people vaccinated can we soon reach herd immunity so that our society can return to normality.
Q: Do you have any suggestion for diabetic patients during the pandemic?
A: People with diabetes should work closely with their care team to control their blood glucose, blood pressure, blood cholesterol and body weight through regular follow up visits and self-monitoring. Many of those patients need to take medications to protect their blood vessels and kidneys and they should follow medical advice. Before the pandemic settles and herd immunity is achieved, they should stay vigilant, continue to wear masks in public places, keep social distancing and maintain personal hygiene. Finally, whether people have diabetes or not, we should avoid being overweight or obese, take healthy diets (3 low 1 high), quit smoking, keep active, sleep well and be positive.
1 CUHK Researchers Uncover Diabetes as a Potential Risk Factor for COVID-19, and Possible Mechanisms
2 COVID Deaths High When Hospitalized With Diabetes (paragraph 1, 5, 6)
3 Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study
4 Temporal trends in rates of infection-related hospitalisations in Hong Kong people with and without diabetes, 2001–2016: a retrospective study
5 Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease