Risk of incident diabetes was markedly higher among males and in those with more severe COVID-19.
New research has found that the hazard of incident diabetes was significantly higher among individuals who tested positive for SARS-CoV-2, according to findings published in JAMA Network Open.
In addition to other long-term morbidity concerns, emerging evidence suggests that COVID-19 may be associated with changes in the pathophysiology of diabetes. Notably, diabetes has already been established as a risk factor for more severe COVID-19 respiratory outcomes, and SARS-CoV-2 infection is associated with the worsening of preexisting diabetes symptoms.
However, experts have not established whether SARS-CoV-2 infection is associated with transient hyperglycemia during active infection or if metabolic alterations persist. Current data on this issue are sparse, and most published studies have been conducted with relatively small samples or have limitations due to participant selection or outcome ascertainment. To date, studies have mostly identified a small but higher rate of incident diabetes among those with COVID-19 compared to those without COVID-19.
To improve the understanding of this association, investigators conducted a large-scale, population-based cohort study using population-based registries and data sets. The study used data from the British Columbia COVID-19 Cohort, including data on medical visits, hospitalizations, emergency department visits, prescription drug dispensations, chronic conditions, and vital statistics.
Eligible adult participants who tested positive for SARS-CoV-2 were matched on sex, age, and collection date of reverse transcription polymerase chain reaction (RT-PCR) test at a 1:4 ratio with individuals who tested negative. After initial matching of exposure groups and individuals with prevalent diabetes or at long-term care facilities were excluded, the analytic sample consisted of 125,987 individuals who were exposed and 503,948 who were unexposed.
Study participants were followed for a median of 257 days. During that period, events of incident diabetes were recorded among 2472 individuals (0.4%), including 608 who were exposed (0.5%) and 1864 who were unexposed (0.4%). Among those diagnosed with incidence diabetes, 56.4% were female and 43.65% were male.
The diabetes incidence rate per 100,000 person-years was significantly higher in the exposed group compared with the unexposed group (672.2 incidence vs 508.7 incidents). The risk of incident diabetes was also markedly higher among males and in those with more severe SARS-CoV-2 disease.
These findings suggest that COVID-19 infection may continue to be associated with outcomes in organ systems involved in regulating blood glucose and may have contributed to the 3% to 5% of excess incident diabetes cases found in the study. At a population level, SARS-CoV-2 infection may be associated with a higher burden of diabetes, as well.
The authors noted that the major strength of their study was the comprehensive population-based capture of SARS-CoV-2 infection and integration of these data with population-based registries and health care-use databases to identify incident diabetes and potential confounders. Additionally, compared with most previous studies, this research had a longer follow-up time, enabling investigation of the hazard of diabetes as a long-term sequela of COVID-19.
Naveed Z, Garcia HAV, 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