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The Influenza Vaccine Antibody Response in T2DM Patients

New research shows similar response in seniors with diabetes as those without.

The development of T2DM has been known to alter the immune system with increasing age. When the immune response is altered in older people with T2DM, they become more susceptible to influenza and its complications. Vaccination against influenza has shown poor efficacy in the older population and especially in patients with diabetes. Therefore, researchers studied the antibody response to vaccination in elderly diabetic subjects compared to healthy individuals.

Researcher Janet E. McElhaney, MD, of the Advanced Medical Research Institute of Canada, and colleagues examined data from 102 adults with T2DM and 119 healthy adults. These subjects were aged 65 years or older with mean average for both groups being 75 years. In the T2DM group, subjects were allocated metformin (n=68), sulfonylurea (n=10), or repaglinide (n=24). All subjects underwent influenza vaccination between 2010 and 2012 receiving the standard dose of the seasonal, trivalent, split-virus vaccine.

Researchers collected blood samples before participants were vaccinated and again 28 days post vaccination. In addition, hemagglutination inhibition (HIA) assays were used to assess the immunogenicity of the influenza vaccine. All subjects were assessed for physical activity and clinical frailty through a grip strength test and 6-minute walk test.

Data analysis shows that the healthy group HIA ratio was negatively associated with HDL and the Physical Activity Scale for the Elderly (PASE), and positively associated with white cell count. In the T2DM group HIA was negatively associated with LDL, glucose, waist circumference and PASE. Researchers found no significant difference in the HIA ratio on day 28 between both groups.

Authors believe that control of T2DM influences the response to influenza vaccination, suggesting that better glycemic control and less frailty may improve immune response. Nonetheless, data strongly suggests that influenza vaccine should be given to elderly T2DM patients.

Practice Pearls:

  • Older adults with well-controlled T2DM who receive the influenza vaccine show a similar antibody response to that of healthy age-matched controls.
  • The control of T2DM, such as glucose and the metabolic-related parameters positively influence the response to influenza vaccine.
  • Better diabetic control and less frailty may prevent hypo-responsiveness to the influenza vaccine in elderly T2DM patients.
  • Data strongly suggests that influenza vaccine should be administered to elderly T2DM patients.

McElhaney, Janet E., et al. “Predictors of the antibody response to influenza vaccination in older adults with type 2 diabetes.” BMJ Open Diabetes Research & Care 3.1 (October 13, 2015): e000140.