If you’re living with diabetes, you may have questions about the COVID-19 vaccine if you haven’t yet been inoculated. Or maybe you’ve already gotten the jab: So far, nearly 200 million Americans are fully vaccinated against COVID-19, including many with diabetes, according to the Centers for Disease Control and Prevention (CDC). And yet if you fall into the latter group, you may be curious to know whether you qualify or would benefit from a booster shot, a subject you’ve likely seen in the news recently.

Long story short: It is especially important for people with type 1 or type 2 diabetes to receive vaccinations for COVID-19 because they are at increased risk for severe illness and death from the novel coronavirus, notes the CDC. Experts say the vaccines are safe and effective for these individuals.

The same goes for the COVID-19 boosters that are currently available. “You should prioritize your health and take time to get the booster when it is available,” says Robert Gabbay, MD, PhD, chief science and medical officer for the American Diabetes Association (ADA) in Arlington, Virginia. “The U.S. Food and Drug Administration (FDA) has reviewed an incredible amount of information to decide on the safety and prioritization of booster vaccinations.”

Here’s an overview of what else you need to know about the COVID-19 vaccines — and those boosters you’ve been hearing about — if you have diabetes.

1. What COVID-19 Vaccines Are Currently Available?

Three COVID-19 vaccines are currently available in the United States:

Pfizer-BioNTech, available to people 12 years and older
Moderna, available to people 18 years and older
Johnson & Johnson’s Janssen, available to people 18 years and older

Pfizer-BioNTech and Moderna’s vaccines require two shots and offer full vaccination two weeks after the second shot. Johnson & Johnson’s Janssen vaccine requires one shot and offers full vaccination two weeks after the shot.

2. Are People With Diabetes Eligible for a COVID-19 Booster?

“People with diabetes are at higher risk for complications from COVID and therefore are priority individuals for a vaccine booster based on FDA approval,” says Dr. Gabbay. As of October 20, a COVID-19 vaccine booster shot is available for people who received the Pfizer-BioNTech vaccine or the Moderna vaccine at least six months ago, according to the FDA. People who got the Johnson & Johnson vaccine are also eligible to receive that vaccine’s booster at least two months after receiving the single dose. People who received one type of vaccine may receive a different type of booster — that is, people may “mix and match” vaccines, the FDA says.

The CDC says these groups should get a booster:

Seniors ages 65 and older
People ages 18 or older who live in long-term care settings

The CDC says these groups may get a booster:

People ages 18 and older with underlying medical conditions, including type 1 or type 2 diabetes, based on their individual benefits and risks
People ages 18 or older who live or work in high-risk settings such as homeless shelters, grocery stores, healthcare facilities, or schools
Additional people, depending on doctors’ evaluation of their benefits and risks

After the CDC’s recommendations, each individual state rolls out its booster program.

Boosters are important because studies have shown that vaccine protection against SARS-2 coronavirus can decrease over time and be less protective against the delta variant, according to the CDC website.

3. What Should People With Diabetes Ask Their Providers About the Boosters?

If you have questions about whether you should get a booster, talk to your healthcare provider, along with reading the CDC website for the most current updates for patients on boosters.

A healthcare provider can guide you on the timing of the booster and how to treat any of the mild side effects that may occur after vaccination, says Gabbay.

Gabbay says a person with diabetes should consider asking these questions, which are edited for brevity:

How much extra protection will I receive from a booster, and is it enough to outweigh the negative side effects I may experience?
How many boosters do you expect that I will receive, considering the first is coming after six months? Will boosters be more likely for people with compromised immune systems?
If I decide not to get a booster, what are my risks?
Are there specific concerns with the boosters for people with diabetes?
How does having diabetes affect the efficacy of the vaccine over time, and for those who may or may not choose to get a booster?

4. Are COVID-19 Vaccines Free for People With Diabetes?

The COVID-19 vaccine, including boosters, is free for everyone, regardless of diabetes status, according to the CDC. But some providers administering the vaccine may charge a fee, which can be reimbursed by your public or private health insurance, or by the Health Resources and Services Administration’s Provider Relief Fund if you do not have insurance.

5. Why Is It Important to Get the Vaccine if You Have Diabetes?

“It’s quite clear that people with diabetes do much worse than people without diabetes in terms of their outcomes with COVID,” says Gabbay.

Early in the pandemic, a study from the CDC, published in July 2020 in the Morbidity and Mortality Weekly Report, found that roughly half of people who died from COVID-19 under age 65 had diabetes.

Two studies from the United Kingdom showed similar risk. A study published in October 2020 in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 diabetes were 2 to 3 times more likely to die from COVID-19 in the hospital than people without diabetes. And a study published in December 2020 in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 were more likely to die or to be treated in the intensive care unit for COVID-19.

More recently, in a study published in September 2021 in Diabetes Care, researchers analyzed data from 18 months into the pandemic, and found that 30 to 40 percent of people who died or experienced severe outcomes from COVID-19 had type 1 or type 2 diabetes. Once hospitalized, a quarter of all patients with diabetes are likely to die, the researchers concluded.

The protective effects of vaccines are critical for people with diabetes who are at increased risk for severe and deadly infection from COVID-19, says Justin Gregory, MD, assistant professor of pediatrics at Vanderbilt Children’s Hospital in Nashville, Tennessee, who has type 1 diabetes.

His study published in December 2020 in Diabetes Care suggested that people with type 1 or type 2 diabetes are 3 times more likely to be hospitalized or experience severe COVID-19 illness compared with people without diabetes.

Vaccinations for Black, Latino, and Native Americans are critical because these communities are disproportionately affected by both diabetes and COVID-19. African Americans and Latino Americans are over 50 percent more likely to have diabetes than white Americans, according to the ADA. Black, Latino, and Native Americans experienced a death rate from COVID-19 double or more than white Americans in 2020, according to the CDC.

6. Are the Vaccines Safe and Effective for People With Diabetes?

People with diabetes were included in the trials of all three vaccine currently available in the United States. And they are part of studies evaluating the real-world safety and effectiveness of the vaccines.

The Pfizer-BioNTech vaccine received full approval from the FDA in August 2021 for people 16 and older. It was also the first to receive emergency use authorization from the FDA in December 2020, and that emergency use authorization continues for people 12 to 15 years old. The Moderna vaccine received emergency use authorization in December 2020 for people 18 years and older.

A study of 5,000 healthcare workers published in September 2021 in The New England Journal of Medicine (NEJM) found that the Pfizer and Moderna vaccines were, respectively, 88.8 percent and 96.3 percent effective at preventing infection with symptoms.

“Our study showed that complete vaccination with mRNA vaccines was effective in adults with more than one risk factor for severe COVID-19; in adults with obesity, hypertension, asthma, or diabetes; and in adults 50 years of age or older,” the study’s authors write.

The one-dose Johnson & Johnson vaccine is 66 percent effective at preventing moderate to severe COVID-19 disease 28 days after vaccination in clinical trials around the world; in U.S. trials it was 72 percent effective, according to phase 3 clinical trials. There were no deaths or hospitalizations from COVID-19 among people vaccinated during the J&J clinical trial. It received emergency use authorization from the FDA on February 27, 2021.

Buddy Creech, MD, MPH, is director of the Vanderbilt Vaccine Research Program in Nashville, Tennessee, was part of the phase 3 trials of the Moderna COVID-19 vaccine. “We wanted to make sure we recruited a number of individuals who had the types of underlying medical conditions that can make COVID more severe,” Dr. Creech says.

That included people with diabetes, hypertension, and obesity, he adds. The vaccines were well tolerated, highly efficacious, and elicited an immune response in people with underlying conditions, such as diabetes, says Creech.

People with type 1, type 2, and gestational diabetes participated in the Moderna clinical trial, he adds. The FDA filing from Pfizer-BioNTech says the trial included people with diabetes but does not specify among types. And the FDA filing from J&J says the trial included people with type 1 and type 2 diabetes.

“People with diabetes are going to be prioritized [for COVID-19 vaccination] because we know they’re at increased risk for disease. And they should feel confident that someone a whole lot like them was enrolled in the clinical trial so that we can say with a greater degree of certainty that they can effectively get this vaccine,” says Creech.

Gabbay says that the data does not suggest the COVID-19 vaccines pose particular risk for people with diabetes. He also says there is no reason to think there would be interactions with insulin or other medications that people with diabetes might take.

7. What Side Effects of the Vaccine Should People With Diabetes Pay Attention To?

In general, the most common side effects of both vaccines are pain, swelling, and redness at the injection site. Other common side effects are chills, tiredness, and headaches. Most of these side effects are mild, but some people had more severe reactions that interfered with daily activities.

Both the Moderna and Pfizer vaccines carry a warning label for increased risk for inflammation of the heart called myocarditis. In an analysis published in September 2021 in NEJM researchers reported the Pfizer vaccine had a rare, but increased risk for myocarditis. This is more common in young men, according to two studies published in October 6, 2021, in NEJM. However, infection with COVID-19 carries an even greater risk of myocarditis.

Gabbay says side effects of the COVID-19 vaccines are similar to those of flu vaccines. For someone living with diabetes, keeping a sick-day kit with extra medications and supplies is beneficial in case you do not feel well after inoculation.

Learn more about the rollout of COVID-19 vaccines for people with type 1 and type 2 in Diabetes Daily's article COVID-19 Vaccine for People With Diabetes: What's Going On?

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