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Clinical characteristics of Chinese diabetic patients and their antibody responses to Omicron subvariants
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DOI：10.3389/fimmu.2026.1909061.png)
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Abstract
En 中文
BackgroundThe ongoing circulation of SARS-CoV-2 Omicron sublineages continues to threaten vulnerable populations such as individuals with diabetes mellitus. Diabetes is well documented to impair host immune function; however; the correlation between clinical manifestations and cross-variant neutralizing immunity against evolving Omicron strains remains poorly characterized in diabetic patients during large-scale Omicron outbreaks.MethodsA cross-sectional study was conducted after the nationwide Omicron surge in China from April to June 2023. A total of 200 diabetic patients and 200 age-comparable healthy controls (HCs) were enrolled. We systematically compared their clinical symptoms; serum anti-RBD IgG levels; and neutralizing antibody (NAb) geometric mean titers (GMTs) against Omicron BA.4/5 and XBB.1.5 using a pseudovirus neutralization assay.ResultsClinically; diabetic patients exhibited a significantly lower prevalence of high-grade fever (≥38 °C; 11.8% vs. 46.1%; P<0.001) and myalgia (1.5% vs. 37.0%; P<0.001) compared with HCs. Immunologically; anti-RBD IgG concentrations were markedly reduced in the diabetic group (P<0.01). While NAb titers against BA.4/5 were comparable between the two cohorts (P>0.05); diabetic patients had drastically diminished neutralizing activity against the immune-evasive XBB.1.5 variant (GMT: 18.9 vs. 59.6 in HCs; P<0.001). Diabetic individuals also showed a far greater fold reduction in cross-variant neutralizing capacity from BA.4/5 to XBB.1.5 than HCs (P<0.001). Gender stratification revealed higher BA.4/5-specific NAb titers in female participants across both groups. Age was negatively associated with BA.4/5-specific NAb titers in both diabetic patients and healthy controls; whereas XBB.1.5 neutralization was uniformly low irrespective of age; which may reflect an age-independent susceptibility of diabetic patients to immune-evasive variants.ConclusionsDiabetic patients showed a distinct self-reported symptom profile; characterized by lower reported frequencies of high-grade fever and myalgia; but also exhibited reduced cross-variant neutralizing activity; particularly against the immune-evasive XBB.1.5 sublineage. The reduced XBB.1.5 neutralizing activity observed in diabetic patients highlights the need for targeted immunological monitoring and risk management during waves of immune-evasive SARS-CoV-2 variants.
Keywords:
diabetes mellitus
COVID-19
clinical characteristics
Omicron variant
humoral immune response
pseudovirus neutralization assay
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