COVID-19-Related Trends and Characteristics of Type 2 Diabetes Mellitus and Metabolic Syndrome

Abstract

Background Although there have been several studies associating obesity with severe coronavirus disease 2019 (COVID-19) outcomes, the potential impact of the pandemic on type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) incidence is less clear. Furthermore, reports on the characteristics of these patients during the pandemic have been scarce. Objectives The purpose of this retrospective study was 1) to explore the impact of the COVID-19 pandemic on T2DM and MetS incidence, and 2) to describe sex-based differences in the characteristics of T2DM and MetS patients during the COVID-19 pandemic. Methods Using electronic health records (EHRs) obtained from the USA-based TriNetX research database (TriNetX, Cambridge, MA), the incidence and the total number of patients with "T2DM (ICD-10-CM: E11)" and "MetS (ICD-10-CM: E88.81)" prior to and during the COVID-19 pandemic were determined. Aggregate lab data from EHRs were extracted and statistical analyses on the lab values and patient demographics including sex, race/ethnicity, and comorbidities were performed. Results After analyzing T2DM and MetS patient data from 2018, 2019, and 2020, we observed a considerable decrease in both T2DM and MetS incidence, with data in April 2020 exhibiting the largest decrease when compared to other months. Furthermore, monthly male T2DM and MetS patients' lab data revealed worsening parameters in April 2020, such as hemoglobin A1c (HbA1C) and blood glucose, when compared to females. Demographic data during 2020 revealed that male T2DM and MetS patients had a significantly higher prevalence of comorbidities including hypertension, ischemic heart disease, and heart failure, but female T2DM and MetS patients had significantly higher asthma comorbidity. Conclusions During 2020, there was a marked decrease in T2DM and MetS diagnosis. Due to a lack of screening, these data may suggest a subsequent increase in T2DM and MetS-related heart disease in the future and may magnify the existing sex-related differences identified in these patients.

Keywords: blood glucose; covid pandemic; hemoglobin a1c; metabolic syndrome; type 2 diabetes mellitus.

Figure 1. Type 2 diabetes mellitus (T2DM) patients seen in a healthcare setting during the COVID-19 pandemic

Panel A: Total number of T2DM patient visits, and first-time T2DM-diagnosis patients (incidence) in 2018, 2019, and 2020. Panel B: Normalized number of patients with T2DM during the pandemic using 2018 counts as a control. Panel C: Normalized T2DM patient incidence during the pandemic using 2018 counts as a control COVID-19: coronavirus disease 2019

Figure 2. Metabolic syndrome (MetS) patients seen in a healthcare setting during the COVID-19 pandemic.

Panel A: Total number of MetS patient visits, and first-time MetS-diagnosis patients (incidence) in 2018, 2019, and 2020. Panel B: Normalized number of MetS patients during the pandemic using 2018 counts as a control. Panel C: Normalized MetS patient incidence during the pandemic using 2018 counts as a control COVID-19: coronavirus disease 2019

Figure 3. HbA1C and blood glucose values of male vs. female type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) patients from January to December 2020

Panel A: Elevated HbA1C in male T2DM patients (n=106,655) compared to female T2DM patients (n=102,907) from January to December 2020. Panel B: Elevated blood glucose in male T2DM patients (n=143,914) compared to female T2DM patients (n=138,151) from January to December 2020. Panel C: Elevated HbA1C in male MetS patients (n=4,111) compared to female MetS patients (n=7,189) from January to December 2020. Panel D: Elevated blood glucose in male MetS patients (n=5,003) compared to female MetS patients (n=8,500) from January to December 2020 Error bars indicate standard deviation. *Indicates significant differences between male vs. female by an unpaired t-test, p<0.01 HbA1C: hemoglobin A1c

Figure 4. HbA1C and blood glucose values of male vs. female type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) patients in April 2020

Panel A: Elevated HbA1C in male T2DM patients (n=6,049) compared to female T2DM patients (n=5,339) in April 2020. Panel B: Elevated blood glucose in male T2DM patients (n=8,219) compared to female T2DM patients (n=7,313) in April 2020. Panel C: Elevated HbA1C in male MetS patients (n=230) compared to female MetS patients (n=374) in April 2020. Panel D: Elevated blood glucose in male MetS patients (n=275) compared to female MetS patients (n=445) in April 2020 Error bars indicate standard deviation. *Indicates significant differences between males vs. females by an unpaired t-test, p<0.01 HbA1C: hemoglobin A1c