Rapid Progression of Prediabetes to Diabetes after Booster Dose

A 69-year-old male with a past medical history of hypertension and prediabetes presented with worsening fatigue, polyuria, polydipsia, blurry vision, and 14 pounds of weight loss over three weeks that started soon after receiving the 3rd booster dose of BNT162b2 mRNA vaccine. He also reported intermittent upper abdominal pain and episodic ambulatory lightheadedness for two weeks. He also reported a loss of taste and smell for two weeks with a diminished appetite. His family history was significant for some members with Graves' disease and celiac disease. He was a non-smoker with no alcohol or illicit drug use. On examination, he was afebrile with normal blood pressure, sinus tachycardia, and mild tachypnea. Physical exam was remarkable for mild upper abdominal tenderness and dry oral mucosa. 

Complete blood count (CBC) was normal; blood glucose was severely elevated with mild corrected hyponatremia; elevated anion gap metabolic acidosis with glucosuria and ketonuria. He received an insulin drip, normal saline, and potassium in the intensive care unit. 

On a three-week endocrinology follow-up, his repeat HbA1c improved to 10.3%. He continues to be insulin dependent and regularly follows up with his physician.

Another report describes 64-year-old female with hypertension (HTN) and pre-diabetes mellitus (DM) (for 20 years) who developed new-onset Latent Autoimmune Diabetes in Adults (LADA) (presenting with diabetic ketoacidosis) one week after 2nd dose of Pfizer-BioNTech COVID-19 vaccine.

A recent study from the Smidt Heart Institute at Cedars-Sinai Medical Center found that the combined risk of Type 2 diabetes after COVID-19 exposure—accounting for both vaccinated and unvaccinated patients—was 2.1%, with 70% occurring after COVID-19 infection versus 30% happening prior to COVID-19 exposure. The risk of Type 2 diabetes after COVID-19 exposure for unvaccinated patients was 2.7%, with 74% occurring after COVID-19 infection versus 26% happening prior to COVID-19 exposure. The risk of Type 2 diabetes after COVID-19 exposure for vaccinated patients was 1.0%, with 51% occurring after COVID-19 infection versus 49% happening prior to COVID-19 exposure.


REFERENCE

Kshetree B, Lee J, Acharya S. COVID-19 Vaccine-Induced Rapid Progression of Prediabetes to Ketosis-Prone Diabetes Mellitus in an Elderly Male. Cureus. 2022 Sep 6;14(9):e28830. doi: 10.7759/cureus.28830. PMID: 36225440; PMCID: PMC9535996.

Bally K, Ji B, Soni L. COVID-19 Vaccine-Induced Latent Autoimmune Diabetes in Adults. Cureus. 2023 Jan 14;15(1):e33762. doi: 10.7759/cureus.33762. PMID: 36793809; PMCID: PMC9924027.

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