Glycemic Effects of the COVID-19 Booster Vaccine in Type 1 Diabetes

Completed

• Conditions: Type 1 Diabetes; Diabetes Mellitus, Type 1
• Interventions: Device: CGM

• Registration Number: NCT05233592
• Lead Sponsor: Johns Hopkins University

Brief Summary

Vaccines for COVID-19 are an essential part of combating the coronavirus pandemic. Vaccines "prime" the immune system against an invader (in this case the SARS-CoV-2 virus) by causing a temporary increased immune or inflammatory response. Inflammation can temporarily increase sugar levels and/or insulin requirements among patients with diabetes. The purpose of this study is to investigate whether the "booster" COVID-19 vaccine dose causes temporarily increased sugar levels and/or insulin dose requirements among patients with Type 1 Diabetes (T1D).

Detailed Description

Over 30 million people in the US have diabetes. It's well known that acute inflammation can temporarily increase blood sugar levels (hyperglycemia) and insulin resistance among patients with diabetes, particularly those with type 1 diabetes (T1D). Vaccines cause an inflammatory reaction, because the vaccines prime the body's immune system against a potential virus. Reports have described temporary hyperglycemia and/or insulin resistance after COVID vaccine administration. However, to date this has not been studied in a rigorous fashion. The objective of the study is to determine if the COVID-19 booster causes increased sugar levels and insulin dose adjustments in patients with T1D. This is a study in adult patients with Type 1 Diabetes who have not yet received the COVID-19 booster vaccine. The study consists of two short outpatient (clinic) visits. Visit 1 occurs 3-5 days before receiving the COVID-19 booster vaccine (pre-vaccine visit). During this visit, the participant will fill out a questionnaire and have a blinded Dexcom G6 Pro CGM applied to the participant. An optional second "backup" Dexcom G6 Pro CGM will be provided, in case the first continuous glucose monitor (CGM) falls off accidentally. Visit 2 occurs 10 days after Visit 1 (about 5 days after receiving the first or second booster vaccine shot), at which time the CGM would be removed. Participants will continue participants' usual routine diabetes care while participating in the study, including using the participants' own glucometer or CGM. Participants will also be asked to keep track of participants' insulin doses administered during the 10-day study.

Study Timeline

• Study First Submitted: 2022-02-09
• Study First Submitted QC: 2022-02-09
• Study First Posted: 2022-02-10
• Study Start: 2022-03-08
• Primary Completion: 2023-04-04
• Study Completion: 2023-04-04
• Status Verified: 2023-05
• Last Update Submitted: 2023-05-16
• Last Update Posted: 2023-05-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 21

Inclusion Criteria

1. Adult (age ≥18yo)
2. Type 1 Diabetes
3. Is already fully vaccinated against COVID-19 (e.g. received 2 doses of Pfizer or Moderna or one dose of Johnson & Johnson)
4. Available to receive a COVID-19 booster vaccine (first or second booster dose)

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Exclusion Criteria

1. Has already received a COVID-19 booster vaccine dose
2. Known physical or psychological disorder which would prohibit the patient from complying with the study procedures (e.g. allergy to adhesive, profound skin disorder, known to have severe adverse reactions previously to CGMs, poorly controlled schizophrenia, etc.)
3. Recent, acute, or chronic medical condition which may significantly affect insulin resistance or measurements of glucose (e.g. severe cirrhosis, acute infection, cancer on chemotherapy, etc.)
4. On a medication known to cause significant hyperglycemia (e.g. supraphysiologic dose of steroids) or negatively affect readings of CGM (e.g. supraphysiologic doses of acetaminophen (e.g. >4g/d)).
5. Pregnant or actively trying to get pregnant
6. Planned PET, CT, or MRI test in the next 10 days
7. Unwilling or unable to keep track of insulin usage during the study

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
T1D Patients Using CGM	CGM	Type 1 Diabetes patients using CGM who have received COVID-19 vaccine booster shot (first or second)

Primary Outcome Measures

Name	Time	Method
Total Daily Insulin Resistance (TDIR)	Day 1 post-vaccine as compared to baseline	Mean glucose multiplied by total daily insulin dose.

Secondary Outcome Measures

Name	Time	Method
Change in Time in Range	Day 1 post-vaccine as compared to baseline	Percentage of time that the participant's blood sugar is between 70-180mg/dL.
Change in Daily Insulin Requirement	Day 1 post-vaccine as compared to baseline	Total Daily insulin dose.
Change in Time in Hyperglycemia	Day 1 post-vaccine as compared to baseline	Percentage of time that participants' sugar level is above 180mg/dL.
Change in TDIR	Days 1 to 5 post-vaccine as compared to baseline	Mean glucose multiplied by total daily insulin dose.

Trial Locations

Locations (1)

Cardiovascular Specialists of Central Maryland; 🇺🇸 Columbia, Maryland, United States