COVID-19 infection linked to increased risk of new-onset diabetes: JAMA

"Our study underscores the importance of clinicians and health agencies being aware of the potential long-term COVID-19 consequences and monitoring people following COVID-19 infection for new diabetes onset for timely diagnosis and treatment," the researchers wrote.

SARS-CoV-2, since its emergence in December 2019, has led to significant mortality and morbidity. While acute infection primarily affects the respiratory system, other organ systems are involved, leading to various acute and chronic sequelae. Initial public health measures and research focused on understanding transmission, treatment of acute infection, disease severity, and prevention interventions. However, efforts to better understand the long-term sequelae and broader consequences of COVID-19 are now given importance.

Among other long-term sequelae of COVID-19 infection, emerging evidence has suggested that COVID-19 may be linked with changes in the pathophysiology of diabetes, but population-based evidence remains sparse.

To improve the understanding of the association between SARS-CoV-2 infection and incident diabetes, Zaeema Naveed from British Columbia Centre for Disease Control in Vancouver, British Columbia, Canada, and colleagues evaluated the association between COVID-19 infection, including the severity of the condition and risk of diabetes in a population-based cohort study.

The study, conducted from 2020 to 2021, used the British Columbia COVID-19 Cohort. It included patients tested for SARS-CoV-2 by real-time RT-PCR (reverse transcription-polymerase chain reaction). Those who tested positive for SARS-CoV-2 (exposed group) were matched for age, sex, and collection date of the RT-PCR test at a ratio of 1:4 ratio to those who tested negative (unexposed group).

The study's primary outcome was incident diabetes (not insulin-dependent or insulin-dependent) identified more than 30 days after the specimen collection date for the SARS-CoV-2 test with a validated algorithm based on hospitalization records, chronic disease registry, medical visits, and prescription drugs for diabetes management.

The evaluation between SARS-CoV-2 infection and diabetes risk was evaluated, and the interaction of SARS-CoV-2 infection with diabetes risk by sex, vaccination status, and age was assessed.

The study revealed the following findings:

• Among 629 935 individuals (median age, 32 years; 51.2% females) tested for SARS-CoV-2 in the analytic sample, 125 987 individuals were exposed, and 503 948 were unexposed.
• During the median follow-up of 257 days, events of incident diabetes were observed among 608 patients who were exposed (0.5%) and 1864 individuals who were not exposed (0.4%).
• The incident diabetes rate per 100 000 person-years was significantly higher in the exposed vs nonexposed group (672.2 incidents versus 508.7 incidents).
• The risk of incident diabetes was also higher in the exposed group (hazard ratio [HR], 1.17) and among males (adjusted HR, 1.22).
• Diabetes risk was higher among people with severe disease versus those without COVID-19, including individuals admitted to the intensive care unit (HR, 3.29) or hospital (HR, 2.42).
• The fraction of incident diabetes cases attributable to COVID-19 infection was 3.41% overall and 4.75% among males.

"We found that SARS-CoV-2 infection was linked with a higher risk of incident diabetes overall and among males and that severe disease was associated with a higher diabetes risk among females and males," the authors wrote. They suggested that SARS-CoV-2 infection may have contributed to a 3% to 5% excess diabetes burden, which may be associated with substantial diabetes cases bearing on healthcare needs for managing diabetes and its complications.

Reference:

Naveed Z, Velásquez García HA, Wong S, et al. Association of COVID-19 Infection With Incident Diabetes. JAMA Netw Open. 2023;6(4):e238866. doi:10.1001/jamanetworkopen.2023.8866