The impact of COVID-19 vaccination on Bulgarian patients with uncomplicated type 2 diabetes mellitus as the only chronic condition
DOI:
https://doi.org/10.2478/AMB-2023-0025Keywords:
Bulgaria, COVID-19 vaccination, comorbidities, uncomplicated type 2 diabetes mellitus, mortalityAbstract
Objective: This retrospective study aimed to investigate the impact of COVID-19 vaccination on Bulgarian patient cohorts with uncomplicated diabetes mellitus type 2 as the only documented chronic comorbidity. We conducted a comparison of fully vaccinated and non-vaccinated populations, considering gender, age groups and vaccine type, across ambulatory, hospital, and ICU settings.
Design: Between March 2020 and June 2022, a comprehensive retrospective analysis was conducted on a national level, utilizing data from the Ministry of Health of the Republic of Bulgaria database obtained after a formal written request. The study included a total of 1,126,946 confi rmed COVID-19 patients. Results: Among the 1,126,946 confi rmed COVID-19 patients, 3,792 individuals (0.33% of the total confi rmed cases) had diabetes mellitus as a single chronic condition. Among the 247,441 hospitalized COVID-19 cases, 1,382 patients (0.56% of the total) had type 2 diabetes mellitus. Notably, the majority of patients requiring hospitalization due to supplemental oxygen requirement were unvaccinated women aged between 60 and 69, accounting for 240 patients. The highest mortality rates were observed in both unvaccinated men and women aged between 70 and 79, with 88 patients in each group. Statistical analysis revealed signifi cant fi ndings in favor of reduced rates of ambulatory care [OR = 0.76 (95% CI 0.6471 to 0.8891); p = 0.0006], intensive care admission [OR = 0.38 (95% CI 0.2698 to 0.5282); p < 0.0001], in-hospital mortality [OR = 0.18 (95% CI 0.0864 to 0.3604); p < 0.0001], and ICUrelated mortality [OR = 0.17 (95% CI 0.0893 to 0.3436); p < 0.0001]. The vaccinated cohorts who received BNT162b2 demonstrated the lowest observed death rates, with 9 deaths out of 485 individuals (1.8%) across all age groups.
Conclusion: In conclusion, this retrospective analysis indicates reduced mortality in patients with uncomplicated type II diabetes mellitus who received vaccination against SARS-CoV-2. Vaccinated individuals also showed signifi cant reduction in ICU admissions.
References
Parenica J, Benesova K, Radvan M, et al. COVID-19 vaccine booster signifi cantly decreases the risk of intensive care unit hospitalization in heart failure patients during the Omicron variant wave: A population-based study. Front Cardiovasc Med. 2022, 9:998842. doi: 10.3389/fcvm.2022.998842
Khan QJ, Bivona CR, Martin GA, et al. Evaluation of the Durability of the Immune Humoral Response to COVID-19 Vaccines in Patients With Cancer Undergoing Treatment or Who Received a Stem Cell Transplant. JAMA Oncology. 2022;8(7):1053-8.
Leon BM, Maddox TM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015 Oct 10;6(13):1246-58.
Lee A, Wong SY, Chai LYA, et al. Effi cacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ. 2022 Mar 2;376:e068632.
Boroumand AB, Forouhi M, Karimi F, et al. Immunogenicity of COVID-19 vaccines in patients with diabetes mellitus: A systematic review. Frontiers Immunol. 2022;13:940357.
Frydrych LM, Bian G, O’Lone DE, et al. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leuk Biol. 2018 Sep;104(3):525-34.
Liu S, Jiang C, Liu Y, et al. The eff ectiveness of COVID-19 vaccination against all-cause mortality in patients with type 2 diabetes mellitus: The observation during the initial period of the cancellation of the "Dynamic Zero Policy" in mainland China. Diabetes Res Clin Pract. 2023 Jun;200:110694.
Fedeli U, Amidei CB, Casotto V, et al. Excess diabetes-related deaths: The role of comorbidities through diff erent phases of the COVID-19 pandemic. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2023 May 30.
Sharma P, Behl T, Sharma N, et al. COVID-19 and diabetes: Association intensify risk factors for morbidity and mortality. Biomed Pharmacother. 2022 2022/07/01/;151:113089.
Geca T, Wojtowicz K, Guzik P, Gora T. Increased Risk of COVID-19 in Patients with Diabetes Mellitus-Current Challenges in Pathophysiology, Treatment and Prevention. Int J Environ Res Pub Health. 2022 May 27;19(11).
Hurissi E, Alameer M, Ageeli F, et al. The Association between SARS-CoV-2 Infection and Diabetic Ketoacidosis in Patients with New-Onset Diabetes: A Retrospective Study from a Diabetic Center in Saudi Arabia. Pediatric Reports. 2022;14(4):519-27. doi:10.3390/pediatric14040060.
Khunti K, Aroda VR, Aschner P, et al. The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery. The Lancet Diabetes & Endocrinology. 2022 Dec;10(12):890-900.
Omboni S, Padwal RS, Alessa T, et al. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. Connected Health. 2022 Jan 4;1:7-35.
Bianchi FP, Stefanizzi P, Martinelli A, et al. COVID-19 vaccination hesitancy in people aff ected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis. Vaccine. 2023 Feb 10;41(7):1303-9.
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Journal Acta Medica Bulgarica 
