Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-term Care Facilities: Data From the GeroCovid Vax Study
Enrico Virgilio, Caterina Trevisan, Angela Marie Abbatecola, Alba Malara, A. Palmiéri, Giorgio Fedele, Paola Stefanelli, Pasqualina Leone, Ilaria Schiavoni, Stefania Maggi, Stefano Volpato, Raffaele Antonelli Incalzi, Graziano Onder, the GeroCovid Vax Working Group, Angela Marie Abbatecola, Domenico Andrieri, Raffaele Antonelli Incalzi, Francesca Arenare, Viviana Bagalà, Tatjana Baldovin, Riccardo Bernardi, Alessandra Bianchi, Paola Bianchi, Raffaella Bisceglia, Ivan Bissoli, Fabio Bontempi, Gilda Borselli, Luigi Carlo Bottaro, Elisa Bottoni, Silvia Brandi, Claudio Bravin, Maria Adele Buizza, Carmine Cafariello, Alessia Maria Calabrese, Valeria Calsolaro, M. Canepa, Carla Capasso, Mariagrazia Capuano, Sebastiano Capurso, Gabriele Carbone, M. Carducci, Silvia Carino, N. Cattaneo, Francesco Ceravolo, Maria Angelica Dorotea Chiesara, Danila Clerici, Pierpaolo Clerici, Alessandra Coin, Vieri Collacchioni, Mauro Colombo, Michela Compiano, Giuseppina Costanza, Giovanna Crupi, Roberta Cucunato, Manuela Marina D'Abramo, Emilia D'Agostino, Ferdinando D’Amico, Antonio De Simone, Stefania Vecchio, Maria Deleo, Annalaura Dell’Armi, Tommasina Di Brango, Anna Di Lonardo, Maria Raffaella Di Nanno, Babette Dijk, Luisa Elmo, Giorgio Fedele, Marisa Ferraro, Christian Ferro, Claudia Fiorucci, Francesca Fortunato, Pasquale Froncillo, Doménico Galasso, Nicola Galdiero, Caterina Galdiero, Stefania Gallo, Pier Paolo Gasbarri, Maria Grazia Gennai, Giuliana Ghiselli Ricci, Elisa Giribaldi, Carmen Godeanu, Samuele Gommaraschi, Roberta Granata, Giada Ida Greco, Angela Greco, Antônio Grillo, Gianbattista Guerrini, Mauro Guglielmo, Labjona Haxhiaj, Claudio Giuseppe Iacovella, M. INDINO, Valerio Alex Ippolito, David Kanah, Liudmila Kountsevich, Jovan Leci, Federica Limongi, Agata Lipari, Vincenzo Longo, Stefania Maggi, Alba Malara
Abstract
OBJECTIVE: Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment. RESEARCH DESIGN AND METHODS: For this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents). RESULTS: The mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = -0.20; 95% CI -0.34, -0.06) and 6 months (β = -0.22; 95% CI -0.37, -0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = -0.24; 95% CI -0.43, -0.05 and β = -0.30; 95% CI -0.50, -0.10, respectively), whereas no differences were observed for those using insulin. CONCLUSIONS: Older residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes.