New Covid vaccine - april 2023- are T1's eligible?

fyi - here’s a news story on this below.

My question - are T1 Diabetics defined by the CDC as “immunocompromised” and thus eligible for this vaccine?

When I look at the CDC documentation, they don’t specifically mention diabetics in their current discussion:


Conditions defined as immunocompromised by CDC

People with medical conditions or people receiving treatments that are associated with moderate to severe immune compromise:

  • Active or recent treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ or recent hematopoietic stem cell transplants
  • Severe primary immunodeficiency
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory
  • Chronic medical conditions such as asplenia and chronic renal disease (degree of immune deficit varies)

in other parts of their website, the CDC does say that T1 Diabetics are immunocompromised, but they are not explicit about it in their definition today.

Anyone have a perspective?

NYT Vaccine article 19 april 23

U.S. Authorizes a New Round of Covid Boosters

The New York Times · by Apoorva Mandavilli · April 19, 2023

Older Americans and those with weakened immune systems, groups still particularly vulnerable to the virus, may receive additional shots of the reformulated vaccine, federal officials said.

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The C.D.C. said only about 43 percent of adults 65 and older had received their first booster shot.Credit…Kenny Holston for The New York Times


April 19, 2023, 5:10 p.m. ET

In a nod to the ongoing risk the coronavirus poses to millions of Americans, the Centers for Disease Control and Prevention recommended on Wednesday that adults 65 and older and those with weakened immune systems receive another dose of the reformulated booster that debuted last fall.

The endorsement followed a daylong discussion by the C.D.C.’s expert advisers. The Food and Drug Administration authorized the booster plan on Tuesday, and the C.D.C.’s recommendation was the final administrative step. Eligible Americans will be able to receive booster doses immediately.

Federal health officials are also phasing out the original vaccine formulas created by Pfizer-BioNTech and Moderna, revoking their authorizations in the United States. And instead of needing an initial series of two shots, unvaccinated people will now require just a single dose of the reformulated, or “bivalent,” Covid shot to be considered vaccinated.

Until now, federal officials had required two doses of the older vaccine before recipients could begin to receive the bivalent boosters, a process some experts felt was confusing.

Limited data on the reformulated vaccines indicate that in older adults, the shots offer additional protection against severe disease and death from Covid, although the protection wanes rapidly in the weeks after inoculation.

There are about 53 million adults 65 and older in the United States, accounting for about 16 percent of the population, according to the Census Bureau. And seven million Americans have weak immune systems because of an illness or a medication.

Roughly 250 people in the United States are still dying from Covid-related causes each day, a vast majority of whom are over 70 or have impaired immune systems. The median age of those hospitalized is 75, according to the C.D.C. Yet only about 43 percent of adults 65 and older have received a bivalent booster shot so far.

More on the Coronavirus Pandemic

By this point, most Americans have built up some immunity against the virus, whether through prior infections, vaccinations or both. The new guidelines acknowledge as much, but allow for those still at high risk from the virus to protect themselves, and to do so free of charge.

“The one-size-fits-all policy was simple but not optimal,” said Dr. Jeremy Faust, an emergency medicine physician and health policy expert at Brigham and Women’s Hospital in Boston. “The new regimen acknowledges that there’s now an extraordinary spectrum of Covid risk, from mild to massive, depending on who you are.”

People who are severely immunocompromised, such as organ transplant recipients, may want to opt for booster shots every six months or even more frequently, Dr. Faust said.

The new guidelines come weeks after Britain and Canada recommended additional shots for older adults and immunocompromised people. (Britain recommended the shots for those 75 and older and Canada only for those 80 and older.)

The C.D.C. now says that adults 65 and older may opt for another dose of the bivalent vaccine at least four months after their first shot. Those with weakened immune systems may do so two months after their previous bivalent dose, and may choose to receive more doses in consultation with their health care provider.

In the meeting of C.D.C. advisers on Wednesday, Dr. Camille Kotton, a physician at Massachusetts General Hospital, noted that the new recommendations did not include immunocompromised children 6 months through 4 years of age. That leaves those medically frail children — including recipients of organ transplants — unprotected against the virus, she said.

“As a mom and doctor, this seems like we are leaving them so vulnerable,” she said in an interview.

For most Americans, the F.D.A. plans to encourage annual Covid shots in the fall, much as it does with flu shots. Health officials will decide on the exact composition of the shot in June, based on the version of the virus circulating at the time.

The bivalent vaccine targets the original variant of the coronavirus as well as variants BA.4 and BA.5, which were dominant last summer. But BA.4 and BA.5 were quickly supplanted by newer versions.

The most recent Omicron subvariant, XBB.1.5, now accounts for about 78 percent of cases in the United States, and another version, XBB.1.6, for about 7 percent. So far, the reformulated vaccines seem to prevent severe illness and hospitalization after infection with these variants.

Federal health officials also are making changes to the process for those receiving the initial shots.

Unvaccinated people will receive a single dose of the bivalent vaccine, rather than multiple doses of the original monovalent vaccine. The rationale is that most unvaccinated Americans now presumably have some measure of immunity from a prior infection and may not need two doses at the beginning, the F.D.A. said.

Some experts were sharply critical of the advice. Reams of data suggest that the vaccines are most protective when given in two doses and followed by one or more boosters to reinforce the shield, said John Moore, a virologist at Weill Cornell Medical College.

“F.D.A. has consistently over-interpreted the performance of the bivalent formulation when given as a booster,” Dr. Moore said. “Now it seems to have gone beyond the science and decided it has some kind of magic power as a first dose.”

It may be reasonable to assume that nearly all unvaccinated adults have already been infected at least once and can get by with just a single dose, said Deepta Bhattacharya, an immunologist at the University of Arizona.

“I guess the F.D.A. is just trying to simplify given the reality on the ground,” he said. But “immunologically, you’d want to get two shots if it’s your first exposure.”

The agency could instead recommend two doses of a bivalent vaccine and say that those who know of a prior infection can elect to forego the second dose, Dr. Bhattacharya said. But, he added, “in reality, I doubt a clause like that would make much practical difference.”

The F.D.A. said it had “carefully reviewed the available epidemiologic evidence, scientific publications and data provided by sponsors indicating that a single bivalent vaccine dose provided to individuals previously infected with Covid-19 provides an immune response equal to, or superior to, two doses of the original vaccine.”

“The agency believes that this approach will help encourage future vaccination, particularly among those who have not chosen to be vaccinated to date,” the F.D.A. said in its statement.

The New York Times · by Apoorva Mandavilli · April 19, 2023


@bostrav59 I’ve wondered the same thing since the get go with Covid. Two years ago, T1s didn’t qualify as immuno-compromised, several months later it was a yes, now it appears its a no again… It would be nice if folks would make up their minds one way or the other. On the other side, my wife said, “Didn’t we just get a third booster due to age, now we need another one?! Unless it turns “annual” I think I’m done…”

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“Immunocompromised” can be used to talk about several different conditions, and as far as I can tell it doesn’t have a standard definition beyond the generic notion of inability to mount an adequate immune response to pathogens as a result of disease, mutation, or therapy that suppresses normal functioning. In some but not all diabetics immune function can become impaired, but in any individual case it would take serial bloodwork to discover this. It seems to be mediated by hyperglycemia, so if you’re well-controlled and have no other issues you probably aren’t (although I have a ~5.0 A1C and still often have low white cell counts, who knows why).

Its unclear to me, is this just the bivalent vaccine or something different? I had a bivalent booster back in 2022.

This is the second iteration of the bivalent vaccine. It turns out the vaccines wear off, so they need to get boosted occasionally. [We are probably on our way to an annual “flu” vaccine that includes Covid too. But that’s gonna be a while away.]

It seems like there is currently no official info regarding whether T1 Diabetics are in the immunocompromised group or not. This will probably get worked out locally with your healthcare provider.

Please let us know if you get any additional info … either locally or via the CDC.

In my experience when scheduling a vaccine in the past (always done online–never talked to anyone) the questions I got asked just asked if I was in a specific qualifying group. So the question would be something like “Do you have a condition that causes you to be immunocompromised?” There might be a “such as…” with a list, but those lists are not the only qualifying conditions, just examples. I answer yes to such a question based on being T1. Once I arrive at my appointment, I’ve never had anyone query me further for specifics–they just assume I have an appointment because I need the vaccine. Which I do.
While this may not be the definitive answer you’re looking for, I really don’t think you need to find some specific citation from the CDC for your specific situation. If your answers to the questions asked when you schedule your appointment allow you to schedule the appointment, then you are eligible for the vaccine. QED.


Recalling the initial frenzy for vaccines in early 2021…my recollection is that T1 did not qualify for the early “high risk” rollout of the vaccine, but I also recall that states were differing in their approaches. I went down to my local chain pharmacy and filled out a checklist stating that I was “high risk” at the time (age 64 and T1) but was turned away by a very red-tapeish pharmacist because the cutoff was age 65 at the time and she told me T1 did not qualify. Eventually my turn came based on age and all went well.

I have not been following the plans for this new booster but it would make sense for the CDC to make it widely available to those who want it without a lot of red tape. I don’t expect a high percentage of people to continue getting boosted so they might as well make it easy for those who do want it.


T1s aren’t immunocompromised; the term means that our immune system doesn’t work as effectively as other peoples but that’s not a thing associated with T1D. It’s possible to be both T1 and immunocompromised as a result of some other problem; T1 doesn’t preclude a separate immune system disorder, but there’s absolutely no positive correlation with T1.


Now I’m just an ignorant bumpkin, but when I took a quick look on our wonderful internet, here’s what I found:

Key takeaways:

  • People with diabetes are “immunocompromised.” This means that the immune system can’t fight off infections as well as it should.
  • The high glucose levels of diabetes affects the immune system in many ways. There are changes to the blood vessels, white blood cells, and infection-fighting proteins.
  • If you have diabetes, you’re not more likely to get a COVID infection. But you’re at higher risk for severe COVID and its complications.

This from the following site: Are People With Diabetes Immunocompromised? Yes - GoodRx

So I think the answer to this question is clear as mud. Like @JMe says, I’ll just have to try and schedule it and see what happens.

@Jme, the problem with your approach is that it makes everything subjective - if you think you’re immunocompromised then you are. But I’m looking for a more scientific definition that tells me whether T1 diabetics are or are not, from the CDC would be good.

Maybe the issue is with the term “Immunocompromised” which is itself a bit vague.


The article points out this:

  • The high glucose levels of diabetes affects the immune system in many ways. There are changes to the blood vessels, white blood cells, and infection-fighting proteins.

Here’s an article from 2021 that attempts to clarify the T1 risk factors associated with covid. Skimming it I never found the magic word “immunocompromised”, which implies that immunocompromising does not occur with Type 1 (or 2) diabetes? Not an expert in clinical jargon…but the risk factors are described and they don’t relate to being immunocompromised in this article.

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It’s always been my understanding that T1D is not considered being immunocompromised. The word means “the immune system’s defenses are low, affecting its ability to fight off infections and diseases”. That is not the case with T1D people. They are no more susceptible to illness than any other person without T1D IF they have good T1D care with a decent A1C. I’m intentionally not talking about T2D because I’m not sure if that applies the same with T2D.

But if that’s wrong I’d love to know how their immune system is compromised. They are missing insulin, nothing else.


Considering that non-normal glucose regulation can damage every organ system of the body including damaging red blood cells by glycasation I would be surprised that the immune system is immune.
This paper is titled, “ Type 2 Diabetes and its Impact on the Immune System,” but I don’t think that type 1 or 3c diabetics are safe from damage to the immune system.


Introduction: Type 2 Diabetes (T2D) is a major health problem worldwide. This metabolic disease is indicated by high blood glucose levels due to insufficient insulin production by the pancreas. An inflammatory response occurs as a result of the immune response to high blood glucose levels as well as the presence of inflammatory mediators produced by adipocytes and macrophages in fat tissue. This low and chronic inflammation damages the pancreatic beta cells and leads to insufficient insulin production, which results in hyperglycemia.

Hyperglycemia in diabetes is thought to cause dysfunction of the immune response, which fails to control the spread of invading pathogens in diabetic subjects. Therefore, diabetic subjects are known to more susceptible to infections. The increased prevalence of T2D will increase the incidence of infectious diseases and related comorbidities.
Type 2 Diabetes and its Impact on the Immune System - PMC

Yeah, I read the same one before I posted.

Indeed. Being run over by an 18 wheeler has exactly the same effect, although perhaps quicker and less painful.

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I wonder if the T1D long timers like @Richard157, @Eric or others would consider themselves immunocompromised.

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Probably like all diabetic complications keeping tight control decreased the damage to the immune system. But none of us are without increased risk of whatever.

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That’s the same with any chronic disease really that requires maintenance. As long as you do the maintenance you never get sicker than other non diabetics. I argue its not the disease itself that makes you immunocompromised; rather, poor control over it.

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Sorry for the self-cite, but I noted this above as well. (Scroll up a few to see.) You could say that T1D is not intrinsically an immunocompromising disorder but if unmanaged it can lead to immune response deficiencies. Whether this is true in any person’s specific case depends on their management and other factors, and can only be assessed via serial testing. Your endo or GP can certify whether you in particular have poor immune response if you need some sort of letter to that effect; I ran into this situation when we were being forced back to in-person teaching.

However, there are subtleties concerning whether it’s the disease itself that causes X or poor control over the disease that does it: often when physicians say a disease causes X they have in mind the “normal progression” of the disease, which assumes it has a typical presentation, development, and history. This refers to “what the disease will do of its own accord,” i.e., without management. Interventions are aimed at disrupting the normal course of a disease. Poor control is just the disease reverting to its normal progression; it isn’t, from this perspective, a separate cause of the complication. In this sense, yes, T1D does (or can) make you immunocompromised given the normal “natural history” of the disease.

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But isn’t T1D often believed to have been caused by an immune response? This doesn’t happen in non-diabetics, so it seems it is a “abnormal” immune response. Or the immune system is not working correctly. Therefore, I would submit that the immune system is “compromised.”