Poster Abstract Abstract

(Adults - Diabetes mellitus), #220531908813

Usage of Bacillus Calmette–Guerin Vaccination to Preserve Beta Cell Function in Type 1 Diabetes Mellitus

Mak Woh Wei, Hospital Canselor Tuanku Muhriz; Lee Siow Ping, Hospital Melaka; Norasyikin binti A. Wahab, Hospital Canselor Tuanku Muhriz; Norlela binti Sukor, Hospital Canselor Tuanku Muhriz; Nor Azmi bin Kamaruddin, Institut Jantung Negara

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0102257590

Introduction

The Bacillus Calmette–Guerin (BCG) vaccine is a suspension of live attenuated Mycobacterium bovis to prevent tuberculosis which has been shown to modulate immune responses and decelerate the progression of type 1 diabetes mellitus (T1DM).

Methods

We report a case of T1DM in partial remission after receiving repeated BCG vaccination.
A 57-year-old woman diagnosed to have T1DM at the age of 53, presented with severe diabetic ketoacidosis requiring intubation. HbA1c on presentation was 14.1% with elevated anti–glutamic acid decarboxylase (anti-GAD) of >250IU/ml. She was discharged with basal bolus insulin regime, total daily dose (TDD) of 44 units insulin daily (0.88 units/kg/day).

Results

Total four doses of BCG vaccination was given within 24 months, with the first dose given 6 months after diagnosis. TDD of insulin reduced to 24 units/day (0.48 units/kg/day) 3 months after the first dose, TDD further reduced to 16 units/day (0.32 units/kg/day) after the last dose of BCG vaccination. HbA1c levels remained stable at <6% 3.5 years post diagnosis and fasting C-peptide level increased from 32.23pmol/L to 299.1pmol/L (reference range 370-1470). Patient achieved partial remission of T1DM, which is defined by HbA1c <6% and TDD of insulin ≤0.5 unit/kg/day.

Conclusion

BCG vaccine plays an important role in preserving the pancreatic beta cell function and delaying progression of T1DM. The impact of BCG vaccine on blood glucose appeared to be driven by resetting of the immune system. BCG vaccine acts by releasing tumor necrosis factor which reduces the levels of suppressor T-cells that are responsible for pancreatic islet cell destruction in T1DM. BCG vaccine administration also shifts glucose metabolism from overactive oxidative phosphorylation to aerobic glycolysis.

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