In the JournalsPerspective

Influenza vaccine response similar in older adults with and without type 2 diabetes

Older adults with well-controlled type 2 diabetes who receive the influenza vaccine showed a similar antibody response to that of healthy age-matched controls, according to research in BMJ Open Diabetes Research & Care.

Janet E. McElhaney, MD, of the Advanced Medical Research Institute of Canada, and colleagues analyzed data from 102 adults with type 2 diabetes aged 65 years or older and 119 healthy adults aged 65 years or older (mean age for both groups, 75 years). In the type 2 diabetes group, adults were assigned metformin (n = 68), sulfonylurea (n = 10) or repaglinide (n = 24). All participants underwent influenza vaccination between 2010 and 2012, receiving the standard dose of the seasonal, trivalent, split-virus vaccine. Researchers collected blood samples from all participants before vaccination and again 28 days after vaccination, and used hemagglutination inhibition (HIA) assays to measure the immunogenicity of the influenza vaccine. All participants completed a grip strength test and 6-minute walk test to assess physical activity and clinical frailty score.

Researchers found that the HIA ratio on day 28 did not differ between the cohorts.

“It is of note that the analysis of seroconversion rates, considered to be a protective antibody response to vaccination, showed an equally low number of strong (true) responders in the healthy and [type 2 diabetes] groups with no significant different between the two,” the researchers wrote.

Researchers also found that, in the healthy adult 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 type 2 diabetes group, HIA was negatively associated with LDL, glucose, waist circumference and PASE.

“This suggests that the control of [type 2 diabetes], such as glucose and the metabolic-related parameters, positively influence the response to influenza vaccination,” the researchers wrote. “These results ultimately suggest that better diabetic control and less frailty may prevent hyporesponsiveness.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

Older adults with well-controlled type 2 diabetes who receive the influenza vaccine showed a similar antibody response to that of healthy age-matched controls, according to research in BMJ Open Diabetes Research & Care.

Janet E. McElhaney, MD, of the Advanced Medical Research Institute of Canada, and colleagues analyzed data from 102 adults with type 2 diabetes aged 65 years or older and 119 healthy adults aged 65 years or older (mean age for both groups, 75 years). In the type 2 diabetes group, adults were assigned metformin (n = 68), sulfonylurea (n = 10) or repaglinide (n = 24). All participants underwent influenza vaccination between 2010 and 2012, receiving the standard dose of the seasonal, trivalent, split-virus vaccine. Researchers collected blood samples from all participants before vaccination and again 28 days after vaccination, and used hemagglutination inhibition (HIA) assays to measure the immunogenicity of the influenza vaccine. All participants completed a grip strength test and 6-minute walk test to assess physical activity and clinical frailty score.

Researchers found that the HIA ratio on day 28 did not differ between the cohorts.

“It is of note that the analysis of seroconversion rates, considered to be a protective antibody response to vaccination, showed an equally low number of strong (true) responders in the healthy and [type 2 diabetes] groups with no significant different between the two,” the researchers wrote.

Researchers also found that, in the healthy adult 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 type 2 diabetes group, HIA was negatively associated with LDL, glucose, waist circumference and PASE.

“This suggests that the control of [type 2 diabetes], such as glucose and the metabolic-related parameters, positively influence the response to influenza vaccination,” the researchers wrote. “These results ultimately suggest that better diabetic control and less frailty may prevent hyporesponsiveness.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Edward Chao

    Edward Chao

    McElhaney and colleagues examine whether the antibody response to the influenza vaccine differs between 102 elderly patients with well-controlled type 2 diabetes and 119 healthy elderly patients. This question is crucial, as type 2 diabetes induces changes in the immune response in older individuals that may both render them more susceptible to influenza, and less responsive to vaccination. Interestingly, antibody response to vaccination did not differ between the two groups. Optimal glycemic control and a lower frailty index score appeared to underlie vaccine responsiveness. A surprising result: Cytomegalovirus (CMV) seropositivity was associated with significantly greater response to the influenza vaccination. Caution and further study are warranted, since the functional and clinical parameters (such as Physical Activity Scale for the Elderly scores or glucose levels) did not vary with CMV status, and the type 2 diabetes population was relatively homogenous, as they were on only a single oral agent.

    • Edward Chao, MD
    • Assistant professor of medicine, University of California San Diego School of Medicine

    Disclosures: Chao reports no relevant financial disclosures.