Updated 9-6-2022
This page will be updated as new information becomes available.
On September 1st, the CDC updated its guidance to recommend booster shots. This specifically includes Pfizer-BioNTech for people ages 12 years and older and from Moderna for people ages 18 years and older. The updated boosters have been designed to provide protection for Omicron BA 4 and BA 5 COVID-19 variants.
The CDC expects to recommend updated COVID-19 boosters for children and youths in the coming weeks.
Driving COVID-19 Vaccine Access for Our Community
What Has Breakthrough T1D Done to Advocate for Vaccine Prioritization for the Type 1 Diabetes (T1D) Community:
Breakthrough T1D launched a successful multi-pronged effort to advocate for those with T1D to be categorized as high priority for receiving COVID-19 vaccines starting in the Fall of 2020. Our efforts were guided by the compelling data that shows adults who contract COVID-19 and have diabetes – whether T1D or T2D – have three to four times higher risk of severe illness and hospitalization than those without diabetes.
We provided formal input and advocated to The National Academies of Science, Engineering, and Medicine, the U.S. Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), the Department of Health and Human Services (HHS), and engaged our key champions on Capitol Hill. In addition, we empowered our grassroots network to advocate locally with their state departments of health, governor’s offices, and other key policymakers. As a result, by March 2021, 25+ states had moved to include T1D in their high-risk groups and the CDC updated their prioritization guidance to also include T1D, thus paving the way for the remaining states that adhered to the CDC guidance to follow suit.
In August 2021, we urged the CDC to once again prioritize the diabetes community in any guidelines for booster shots. In September and October, 2021, Pfizer-BioNTech and Moderna boosters were approved, and the CDC continued to categorize T1D as an underlying high-risk condition, thus allowing those living with the disease (age 18+ and 6 months after their second dose of either brand) to receive either of those brands as boosters if they choose – with the option to mix-and-match brands. Also, the CDC recommends that everyone who received the Johnson & Johnson vaccine should receive a booster of any brand at least 2 months after their first dose.
In late November 2021, the CDC expanded its recommendation regarding booster doses for individuals who are 18 years and older. Everyone ages 18 and older should get a booster shot either when they are 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine.
Also, in early December 2021, the CDC stated that vaccinated 16 and 17 year-olds (thus those who received the Pfizer two-dose vaccine series) should receive a booster shot 6 months after their second dose.
Read our FAQ below for more details and answers to common questions.
Frequently Asked Questions (FAQs)
What is Breakthrough T1D’s position on the vaccines?
Breakthrough T1D celebrates the authorization of the Pfizer-BioNTech, Moderna, and Janssen (J&J) COVID-19 vaccines by the U.S. Food and Drug Administration. We appreciate the many research scientists, clinical trial participants, industry partners, and government officials who are making this progress possible.
How do I get a vaccine?
The distribution of vaccines is being organized on a state-by-state basis following guidelines established by the Centers for Disease Control and Prevention (CDC). Please refer to your state department of health to learn more. Also, reference ‘VaccineFinder’ a website that helps you find clinics, pharmacies, and other locations that offer COVID-19 vaccines in the United States. The website is operated by Boston Children’s Hospital and supported by the Centers for Disease Control and Prevention and the United States Digital Service.
How much does the vaccine cost?
All COVID-19 vaccines purchased by the Federal government are free to the patient regardless of health insurance coverage. All providers must vaccinate individuals regardless of their insurance status, type of coverage, and are prohibited from balance billing or otherwise charging recipients for the vaccine.
Are the vaccines safe for people with T1D?
All data show the vaccines are safe and effective for people with T1D and both vaccines were tested in people with diabetes. 9.4% of Moderna, 8.4% of Pfizer-BioNTech, and 0.5% of J&J trial participants had diabetes. There were no adverse effects reported in these populations. We do not have any information on the number of people with T1D in these trials, nor about T1D-specific adverse events reported yet in scientific literature, but there is no evidence at the moment to indicate that these vaccines are unsafe for people with T1D.
When people with T1D have a sickness, e.g. fever, flu, etc., it’s important to follow the guidelines that your practitioner provides. It is possible that a vaccination, like the COVID-19 vaccine or otherwise, can lead to illnesses with similar symptoms. If you become ill following a COVID-19 vaccination, please consult your doctor and follow sickness-related guidelines.
Does it matter which vaccine I get?
On December 16, 2021, the Centers for Disease Control and Prevention (CDC) endorsed updated recommendations made by the Advisory Committee on Immunization Practices (ACIP) for the prevention of serious illness resulting from COVID-19, expressing a clinical preference for individuals to receive an mRNA COVID-19 vaccine (Pfizer-BioNtech or Moderna). According to the CDC’s press release, “ACIP’s unanimous recommendation followed a robust discussion of the latest evidence on vaccine effectiveness, vaccine safety and rare adverse events, and consideration of the U.S. vaccine supply.”
However, if the J&J vaccine is the only one you can receive/the only one available to you, you should receive it as vaccination is the most effective way to prevent serious illness from COVID-19. The recommendations do not say the J&J vaccine is ineffective, rather, they say that the mRNA COVID-19 vaccines are more effective.
Do I Need a Booster Shot?
On November 29, 2021, the CDC expanded its recommendation regarding booster doses for individuals who are 18 years and older. Everyone ages 18 and older should get a booster shot either when they are 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine.
Which Booster Shot Should I Get?
Per the updated clinical guidelines, “Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received and others, may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.”
I received the Janssen (J&J) vaccine – should I be concerned about negative outcomes?
On April 13, 2021, the FDA and CDC recommended a pause in the use of the J&J vaccine so they could review cases of rare and severe blood clots accompanied by low platelets, also known as thrombosis-thrombocytopenia syndrome (TTS), that presented in 6 people after receiving the vaccine. On April 23, the FDA and CDC – following a thorough safety review – have determined that the recommended pause should be lifted and use of the vaccine should resume. In short, the FDA has determined that the available data show that the vaccine’s known and potential benefits outweigh its known and potential risks in individuals 18 years of age and older.
Vaccine recipients or caregivers should review the Fact Sheet for Recipients and Caregivers, which has been revised to include information about the risk of this syndrome, which has occurred in a very small number of people who have received the J&J vaccine. Also, the CDC and FDA state that people who have received the J&J vaccine and develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their healthcare provider.
What about children with T1D?
On June 18th, Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention (CDC), recommended the use of the Moderna and Pfizer-BioNTech COVID-19 vaccines for children 6 months of age and older. This decision comes on the heels of the FDA granting emergency use authorization of the vaccines for this age group on Thursday, June 16th.
The clinical trials showed that both vaccines are safe and effective in these age groups—including people with T1D. Individuals are encouraged to get in touch with their pediatrician to discuss how to get the vaccines.
Who do I talk to about getting a vaccine?
Each state is responsible for distributing the vaccine through the networks of hospitals, doctors, and pharmacies within their jurisdiction. We encourage you to visit your state’s department of health website and get in touch with your doctor to learn more about your state’s process.
Did Breakthrough T1D provide input for national vaccine distribution prioritization?
Breakthrough T1D provided a letter about COVID-19 risks to the T1D community to the CDC, both to CDC staff directly and through formal comments to the Advisory Committee on Immunization Practices, including data published in December 2020. A copy of each letter can be found here and here. Breakthrough T1D also held several meetings with CDC staff to share the latest data regarding the elevated risk of COVID-19 to the T1D community.
In Fall 2020, we also provided input to the National Academies of Science, Engineering, and Medicine, which were seeking input on a proposed framework for vaccine distribution. The CDC is now using this framework.
JDRF, along with other diabetes organizations, sent a letter to the CDC about the urgent need to prioritize people with T1D.
Breakthrough T1D has also been sharing this important data with the news media including being featured in STAT News, a health and medicine focused news website, and contributing to the piece featured in The Hill, a media source for policy and political coverage.
On March 29, 2021, the CDC announced that it has updated their COVID-19 prioritization guidance to include T1D as a high risk condition, thus paving the way for states who follow CDC guidance to include those with T1D in their priority groups.
What Do We Know about T1D and COVID?
- Based on current scientific literature, there is no evidence that people with T1D are at higher risk for contracting T1D.
- Although children with T1D can catch the virus, they usually have mild symptoms. However, the virus could make it harder to manage blood glucose levels and therefore create a risk for diabetic ketoacidosis.
- Two studies show that adults with T1D are at an increased risk of severe COVID-19 illness. Details on each of these studies are below. These add to an October 2020 UK population-based registry publication showing that people with type 1 diabetes have more than 3-fold level of increased risk of mortality when hospitalized due to COVID-19.
- A December 2020 U.S.-based study shows that adults who get COVID-19 and have diabetes, whether T1D or T2D, have three to four times higher risk of severe illness and hospitalization.
- Specifically, the study found “after adjustment for age, race, and other risk factors, the odds of a COVID-19–related hospitalization and greater illness severity for patients with type 1 diabetes are three- to four-fold higher than patients without diabetes. This increased risk is approximately the same for patients with type 2 diabetes.”
- Per this study, “hypertension, race, recent diabetic ketoacidosis, health insurance status, and less diabetes technology use were significantly associated with illness severity.”
- Those at greatest risk are people with consistently elevated blood-sugar levels and those with a second comorbidity (such as obesity or heart, kidney, or lung disease).
- This study “COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes,” by Justin M. Gregory et.al. was published in December 2020 in the peer-reviewed journal Diabetes Care. It was conducted by a clinical research team at the Vanderbilt University School of Medicine and the University of California San Diego Medical Department. The study analyzed data from nearly 6,500 patients with COVID-19 in a regional health network, comparing factors and outcomes in patients with T1D, T2D, or no diabetes.
- A December 2020 study published out of Scotland shows that the risk of serious outcomes among adults with T1D and T2D were significantly higher than compared to a baseline of the general population.
- Specifically, the study found that the risk of severe COVID-19 for adults with diabetes compared to the general population when adjusted for age and sex was 2-4 times higher for T1D and 1-4 times higher for T2D.
- The report indicates that greater elevation in T1D “is probably accounted for by longer duration of diabetes because in the older age bands, cumulative incidence was higher in type 1 than type 2 diabetes…”.
- The study found that the “risk of fatal or critical care unit-treated COVID-19 in diabetes rose steeply with age and was higher in males…”.
- The authors state, “The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history.”
- This study, “Risk of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland” by Stuart J McGurnaghan et al. was published in December 2020 in the peer-reviewed journal Lancet Diabetes and Endocrinology. It was a cohort study conducted by Health Protection Scotland in conjunction with several universities using the total population of Scotland.
- Given the higher risks of severe illness and hospitalization from COVID-19 found in these studies, Breakthrough T1D calls for people T1D and T2D to have prioritized access to the COVID-19 vaccine.
What do we know about COVID variants, the intersections of T1D, and vaccine efficacy?
Currently, there isn’t published research that has studied the SARS-CoV-2 variant and its impact on T1D. The current vaccines approved by the FDA and their efficacy against this new variant in T1D or other populations are still being studied, but we are committed to providing you with updates as soon as we learn more.
* The committee defined frontline essential workers as first responders, teachers and other education workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores.
For more information about Coronavirus, visit https://www.breakthrought1d.org/coronavirus/.
