People with type 2 diabetes are one among the most vulnerable subgroups to COVID-19. Despite high vaccination rates, correlate of protection that prompt vaccinations against emerging SARS-CoV-2 variants of concern and reduce mortality rates in this high-risk group. is as yet absent. Moreover, there is a lack of clarity regarding the level of antibody that could provide protection, as well as the potential impact of the threshold on pre-existing organ damage.

      A prospective study, recently published in ‘Scientific Reports’ delved into the effectiveness of anti-SARS-CoV-2 spike antibodies as a correlate of protection in hospitalized individuals with T2D. The study enrolled a total of 1152 hospitalized patients and a subsequent analysis for Anti-SARS-CoV-2-spike antibody levels was done. Additionally, the researchers were able to analyze creatinine and NT-proBNP levels in only in 1046 patients due to insufficient residual sample. The pre-specified endpoints included all-cause in-hospital-mortality, ICU admission, endotracheal intubation, and oxygen administration, with propensity score matching applied to enhance comparability.

      The findings revealed significantly lower anti-SARS-CoV-2-spike-antibodies in non-surviving patients with diabetes compared to survivors (mean, 95% CI 351BAU/ml, 106–595 vs. 1123, 968–1279, p < 0.001). Mortality risk increased two-fold with each standard deviation-decrease in antibody levels (aHR 1.988, 95% CI 1.229–3.215, p = 0.005). Furthermore, patients requiring oxygen administration, endotracheal intubation, and ICU admission exhibited significantly lower antibody levels compared to those who did not (p < 0.001, p = 0.046, p = 0.011). Consequently, the study team concluded that anti-SARS-CoV-2 spike antibodies upon hospital admission are inversely associated with the need for oxygen administration, endotracheal intubation, intensive care and in-hospital mortality in COVID -19 patients with diabetes. Additionally, the impact of pre-existing comorbidities may outweigh the influence of diabetes status alone on the outcome.