Hyperglycemic crisis (HC) has been reported in patients with COVID-19 infection, but there is little data about HC following COVID-19 vaccination, with 10 patients described to date. We performed a retrospective observational study examining the correlation between COVID-19 vaccination and HC in adult patients admitted from 1/1/21-7/1/21 at our institution. There were 91 admissions for HC during the study period. Forty-one were admissions for diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) , 2 of which also had hyperglycemic hyperosmolar state (HHS) . In patients with type 2 diabetes (T2D) , there were 49 admissions for DKA, 6 of which also had HHS, and 1 admission for HHS alone. In patients with T1D, 17 admissions occurred following COVID-19 vaccination, ranging from <24 hours to more than 3 months after, including 1 new diagnosis of T1D. All cases had a trigger of insulin omission or other medical illness, including 7 with admission for COVID-19 infection. In patients with T2D, 20 DKA or overlap admissions and 1 HHS admission occurred following COVID-19 vaccination, ranging from 1 to 40 days after. Six of these patients had no clear trigger of medical illness or insulin omission, 3 of which were new diagnoses of T2D. Two were following the first vaccination and 4 following the second vaccination. Hemoglobin A1c at admission was >11% in all 6 of these patients. Among patients with T1D, there were no cases of HC that appeared to be attributable to COVID-19 vaccination. In patients with T2D, while there were six cases following vaccination with no other clear trigger, the degree of hemoglobin A1C elevation at the time of admission was suggestive of longer duration of poor glycemic control. Three of these cases did have acute symptom onset following vaccination within one week of presentation, so it is possible that HC was provoked by vaccination in these patients. While it is not clear that COVID vaccination leads to HC in T1D, it may be an acute trigger for HC in patients with T2D who have poor underlying glycemic control. Large scale population studies are needed to better assess rates of HC following COVID-19 vaccination.


K. L. Modzelewski: None. S. Alexanian: None.

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